BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We con...BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.展开更多
BACKGROUND Tuberculous pericarditis(TP)remains a challenge for endemic countries.In developing countries,one to two percent of patients with pulmonary tuberculosis develops TP.CASE SUMMARY A 49-year-old woman presente...BACKGROUND Tuberculous pericarditis(TP)remains a challenge for endemic countries.In developing countries,one to two percent of patients with pulmonary tuberculosis develops TP.CASE SUMMARY A 49-year-old woman presented with dyspnea,chest pain and dry cough.On physical examination,veiled heart sounds were found.The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion.The patient was taken for an open pericardiotomy.The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli.Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive.The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain.CONCLUSION In cases of TP,obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis.Early diagnosis of this entity will allow physicians to initiate timely treatment,avoid complications and improve the patient's clinical outcome,so we consider the description of this case pertinent and its review in the literature.展开更多
文摘BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.
文摘BACKGROUND Tuberculous pericarditis(TP)remains a challenge for endemic countries.In developing countries,one to two percent of patients with pulmonary tuberculosis develops TP.CASE SUMMARY A 49-year-old woman presented with dyspnea,chest pain and dry cough.On physical examination,veiled heart sounds were found.The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion.The patient was taken for an open pericardiotomy.The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli.Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive.The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain.CONCLUSION In cases of TP,obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis.Early diagnosis of this entity will allow physicians to initiate timely treatment,avoid complications and improve the patient's clinical outcome,so we consider the description of this case pertinent and its review in the literature.
