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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
An eFAST (Extended Focused Abdominal Sonography for Trauma) is helpful as an additional assessment tool. The eFAST includes the abdomen for haemoperitoneum, since concomitant intra-abdominal injuries may be present, the precordium for haemopericardium and the chest for lung sliding. Chest wall emphysema may preclude adequate windows for a technically reliable examination. Rapid assessment for the presence of haemopericardium and haemoperitoneum will drive management and operative decisions. There is an important caveat when performing eFAST: it is unreliable in the presence of a haemothorax. A lacerated pericardium with an associated cardiac injury can allow blood to decompress into the plural space. The absence of haemopericardium on eFAST may be incorrectly interpreted as excluding a cardiac injury. In this circumstance, a pericardial window is performed; if positive, it is extended to a median sternotomy.
Treating the cardio-oncology patient
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Pericardial complications, including pericarditis and pericardial effusion, can be well visualized with echocardiography. Prognosis and treatment of pericardial disease in cancer patients is dependent on the underlying cause (48). Pericarditis may be a direct complication of anticancer treatment, especially radiotherapy (49). Pericardial effusion may be a manifestation of the progression of cancer, especially lung cancer (50,51). In some centers the standard treatment for pericardial effusions is pericardiocentesis, with prolonged drainage and subsequent chemotherapy administered to the pericardial space (52). A pericardial window is a palliative cardiac surgical procedure to create a communication from the pericardial space to the pleural cavity. It is performed to avoid recurrent large effusions or cardiac tamponade when the risk for pericardiectomy is high, or when the patients’ life expectancy is short (e.g., end-stage malignancy).
Case 23: Heart and Lungs
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
As pericardial effusions increase, they can reach a critical stage, leading to haemodynamic compromise. In these cases, a pericardiocentesis may need to be carried out under echocardiographic guidance. If the patient develops recurrent, symptomatic pericardial effusions, the cardiothoracic surgeons may consider creating a pericardial window to allow fluid to drain into the pleural cavity.
Permanent indwelling catheter for the management of refractory malignant pericardial effusion
Published in European Clinical Respiratory Journal, 2022
Frederik Schultz Pustelnik, Christian B. Laursen, Arman Arshad, Ahmed Aziz
A control TTE 14 days after the PCC showed recurrence of very large MPcE with swinging heart, compression of the right ventricle and dilated vena cava. Due to recurrent MPcE, the patient was treated with pericardiectomy and establishment of a pericardial window (PW). The procedure was performed thoracoscopic. Nine days after the PW was established, there was no MPcE on TTE, and the treatment with immunotherapy was initiated. The patient was admitted at the Department of Cardiology 18 days after the PW due to shortness of breath. Acute TTE revealed recurrence of MPcE with compression of the right ventricle. An acute PCC with removal of 500 mL fluid was performed. The catheter was left in the pericardial sac. The case study was discussed at a multidisciplinary team conference with attendance of cardiologists and pulmonologists from the lung cancer unit. Due to recurrent MPcE predominantly over the right ventricle, there was an increased risk of complications during repeated PCC and lack of efficiency of the PW. A decision to attempt to place a PiC (PleurX) in the pericardial sac for palliation and possible PCD was made. The patient was informed about the experimental nature of the procedure and a lack of other effective treatment methods. He accepted the PiC treatment.
Postpericardiotomy syndrome after cardiac surgery
Published in Annals of Medicine, 2020
Joonas Lehto, Tuomas Kiviniemi
In the most persistent cases of pericardial effusion, pericardiectomy may be considered [15]. Fortunately, this is needed only in extremely rare cases [68]. Other possible interventional treatments include prolonged pericardial drainage, the aforementioned intrapericardial triamcinolone treatment, and pericardial window [15]. The pericardial window can be performed either by conventional heart surgery, by thoracoscopy, or by balloon pericardiotomy by inserting a deflated single catheter or double balloon catheters into the pericardial space [181]. If the surgery is performed, pericardiectomy is the procedure of choice, because pericardial window may not relieve loculated pericardial fluid or may close soon after being performed [15,59]. If the persistent PPS manifests as large, symptomatic pleural effusions continuing despite several thoracocenteses, thoracoscopy should be considered. At thoracoscopy, any fibrous tissue coating the visceral pleura should be removed and either the parietal pleura should be abraded or talc should be used to create a pleurodesis [182,183]. In addition, a single case report has been published of the use of indwelling pleural catheter for the recurrent pleural effusions secondary to PPS [184].
Myocarditis and carotidynia caused by Granulocyte-Colony stimulating factor administration
Published in Modern Rheumatology Case Reports, 2020
Elena Corral de la Fuente, Arantza Barquín Garcia, Cristina Saavedra Serrano, Juan José Serrano Domingo, Roberto Martín Huertas, María Fernández Abad, Noelia Martínez Jáñez
She was diagnosed with myocarditis with hemodynamic repercussion due to cardiogenic shock and was admitted to the Coronary Care Unit. Due to precious recovery, empirical antibiotics (tazobactam-piperacillin and vancomycin) as well as high-dose steroids were administrated starting at the ED. She also required advanced life support. After five days since admission, Cardiac Magnetic Resonance Image (MRI) and PET/CT showed metabolic enhancement (SUV 5.40) with myocardial diffuse thickening in basal inferolateral segment of left ventricle with severe pericardial effusion (Figure 3). A pericardial window was performed after ten days since admission. Pericardial biopsy and cytology showed unspecific chronic and acute inflammation signs, rich in lymphocytes with mesothelial hyperplasia, without malignant cells, and microbiological study resulted negative.