Iatrogenic tracheobronchial and chest injury
Philippe Camus, Edward C Rosenow in Drug-induced and Iatrogenic Respiratory Disease, 2010
Cardiac laceration, pericarditis, haemopericardium and pericardial tamponade have been reported as rare iatrogenic complications.81 Acute pericarditis following diagnostic or therapeutic procedures have been rarely reported shortly after endoscopic variceal sclerotherapy. In the case of sclerotherapy, the possible pathogenesis is the involvement of the pericardium in an inflammatory reaction that develops in the oesophageal wall and surrounding tissues. Symptoms presented by the patients vary. In a case of cardiac laceration the clinical presentation may be dramatic. In cases where pericarditis is the main issue, symptoms may be mild and this may result in underestimation of the clinical condition. However, prompt diagnosis, follow-up and treatment should be applied in cases with cardiac tamponade or constrictive pericarditis development. Late complications may be fatal and are consequent upon inflammation, sepsis or thromboembolism.
Practice Paper 7: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
This is a classic history for pericarditis. In this case, the patient has a significantly elevated serum urea (possibly due to chronic renal impairment), which irritates the pericardium, leading to an inflammatory response. Other causes of pericarditis include viral infection (Coxsackie virus), autoimmune disease, myocardial infarction, tuberculosis, malignancy, amyloidosis and sarcoidosis. Patients present with retrosternal stabbing pain that may radiate to the shoulder/neck and is worse on movement, inspiration and lying flat. The pain characteristically improves on leaning forward. Patients may have a low-grade fever, and a pericardial rub (high-pitched scratching sound) may be heard on auscultation. ECG may demonstrate saddle-shaped ST elevation and T inversion in random leads. Treatment involves management of the underlying cause and regular NSAIDs for symptomatic relief.
Pericardium
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
The 2015 ESC guidelines for the diagnosis and management of pericardial diseases divided the aetiology of acute pericarditis into two main groups, infectious causes and noninfectious causes (Table 12.2).1 Viruses are considered the most common infective agents, and include coxsackieviruses A and B, echovirus, adenoviruses, parvovirus B19, HIV, influenza as well as multiple herpes viruses such as EBV and CMV. Bacterial causes of pericarditis occur infrequently in the developed world, however, tuberculosis infection is still very prevalent in the developing countries, and is cited as the most common cause of pericarditis in the endemic parts of the world. This is especially true in HIV-positive patients, where the rate of infection is reported to be increasing. Less commonly, other forms of bacteria can cause pericarditis including Coxiella burnetii, Meningococcus, Pneumococcus, Staphylococcus and Streptococcus with cases of life-threatening purulent cardiac tamponade reported in the literature. In extremely rare cases, usually in immunosuppressed individuals, pericarditis can be caused by fungal organisms such as Histoplasma, Coccidioides, Candida and Blastomyces or parasitic species such as Echinococcus and Toxoplasma.
Constrictive pericarditis decades after aortic valve repair
Published in Baylor University Medical Center Proceedings, 2020
Sean Byrnes, Kunal Gada
Pericarditis can be acute or chronic. Acute pericarditis lasts <6 weeks; common etiologies include medications, postmyocardial infarction, and viral infections. Chronic pericarditis lasts >6 months and can lead to development of constrictive pericarditis. Etiologies of constrictive pericarditis include past cardiac surgeries, viral infections, radiation, trauma, or uremia. Our patient had no recent viral infections and no history of radiation, trauma, or uremia. Signs and symptoms of chronic pericarditis include elevated jugular venous pressure, pulsus paradoxus, and right heart failure symptoms, such as dyspnea, ascites, hepatomegaly, pitting edema, and pleural effusions.3 In patients with constrictive pericarditis, the pericardium becomes fibrotic and thickened. This leads to a decrease in compliance of the atria and ventricles, which decreases the blood return, subsequently causing the signs and symptoms described above. While ventricular interdependence is always present, constrictive pericarditis leads to a marked increase of ventricular interdependence due to the increase in right ventricular pressure, causing a decrease in left ventricular end diastolic volume.4
Rechallenging nivolumab following immune checkpoint inhibitor–induced pericarditis
Published in Baylor University Medical Center Proceedings, 2023
Mustafa Rami Ali, Omar Jamil Darwish, Laith Alhuneafat, Bayan Nidal Abdallah, Yacob Saleh
A 47-year-old man was diagnosed with de novo RCC of the right kidney metastatic to the lungs and bone. His International Metastatic RCC Database Consortium risk score was 2 (intermediate; <1 year to treat from diagnosis, elevated neutrophil count [8890/mm3]).2 First-line sunitinib was started, and 2 months later he developed extensive right lower limb deep vein thrombosis. His disease remained stable for 9 months until he underwent right renal artery embolization to control for hematuria. A computed tomography (CT) scan showed disease progression, so he was started on second-line nivolumab. Thirty-six days later, he reported progressive pleuritic chest pain and dyspnea for 31 days. An electrocardiogram (ECG) showed ST-segment depression in the lateral leads and diffuse PR depression, troponin was negative, and an echocardiogram showed mild pericardial effusion. A diagnosis of pericarditis was made.
Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics
Published in Baylor University Medical Center Proceedings, 2021
Mahmoud Abdelnabi, Abdallah Almaghraby, Yehia Saleh, Alyaa El Sayed, Judy Rizk
Purulent pericarditis is typically present as an acute illness characterized by high-grade fever, tachycardia, cough, and less commonly chest pain. In the postoperative setting, most patients with purulent pericarditis also have signs of mediastinitis or sternal wound infection. Cardiac tamponade may also occur.3S. aureus is the most common implicated pathogen, while Streptococcus pneumoniae is the most common organism in the setting of direct extension of an intrathoracic infection. Other causes include gram-positive organisms, fungi, and Mycobacterium tuberculosis. Polymicrobial infections are uncommon.4–6 Pericardial fluid analysis including chemical testing (for protein and glucose content as well as white cell count), microscopy (gram stain, acid-fast stain, and fungal stain), and culture and sensitivity is the mainstay for the diagnosis of purulent pericarditis.7
Related Knowledge Centers
- Chest Pain
- Fever
- Inflammation
- Palpitations
- Shortness of Breath
- Heart
- Pericardium
- Weakness
- Shortness of Breath
- Viral Disease
- Pathogenic Bacteria