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Halloween in the Cath Lab: spider web pericardial effusion.
European Heart Journal - Cardiovascular Imaging ( IF 6.7 ) Pub Date : 2020-03-01 , DOI: 10.1093/ehjci/jez230
Dinu Valentin Balanescu 1 , Teodora Donisan 1 , Nicolas Palaskas 1 , Juan Lopez-Mattei 1 , Cezar Iliescu 1
Affiliation  

A 70-year-old male patient with refractory diffuse large B-cell lymphoma on dexamethasone, fludarabine, and cyclophosphamide was admitted to the intensive care unit for fever and hypotension. Central line-associated blood stream infection with Escherichia coli and fungal pneumonia were diagnosed. Symptoms resolved following treatment with vasopressors and antimicrobials. Computed tomography 1 month later revealed resolving pulmonary lesions and a large pericardial effusion (Panel A) leading to a transthoracic echocardiogram (TTE) that suggested tamponade physiology (Panel B, asterisks). Percutaneous pericardiocentesis was performed under fluoroscopic and echocardiographic guidance. An apical approach was used due to severe thrombocytopenia (platelet count 25 K/µL). Multiple intrapericardial loculations were observed on intraprocedural TTE (Panel C; Supplementary dataSupplementary data online, Video S1). Agitated saline initially filled one loculation (Supplementary dataSupplementary data online, Video S2) and gradually expanded as blunt dissection was performed with a 0.35″ guidewire and 5-Fr Cook pericardial catheter (Panel D; Supplementary dataSupplementary data online, Video S3). Approximately 300 cc of haemorrhagic fluid were removed. Repeat TTE showed resolution of the effusion adjacent to the right atrium and ventricle, but persistent moderate loculated effusion posterior to the left ventricle (Panels E and F, asterisks). On repeat pericardiocentesis, additional blunt dissection was performed and 220 cc of haemorrhagic fluid negative for malignant cells were removed, with complete resolution of the effusion.

中文翻译:

万圣节在Cath Lab中进行:蜘蛛网心包积液。

一名患有地塞米松,氟达拉滨和环磷酰胺难治性弥漫性大B细胞淋巴瘤的70岁男性患者因重度发热和低血压入院重症监护病房。诊断出与大肠杆菌和真菌性肺炎有关的中线相关血流感染。用升压药和抗菌素治疗后症状消失。1个月后的计算机断层扫描显示,肺部病变得以解决,大的心包积液(图A)导致经胸超声心动图(TTE)提示填塞物生理性(图B,星号)。在荧光镜和超声心动图指导下进行经皮心包穿刺术。由于严重的血小板减少症(血小板计数25 K / µL),因此采用了根尖入路。术中TTE观察到多个心包内定位(图C; 补充数据在线补充数据,视频S1)。搅动的盐水最初填充一个位置(在线补充数据,视频S2),并逐渐扩展,因为使用0.35英寸导丝和5-Fr Cook心包导管进行钝性解剖(图D;在线补充数据,视频S3)。去除了大约300 cc的出血液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。搅动的盐水最初填充一个位置(在线补充数据,视频S2),并逐渐扩展,因为使用0.35英寸导丝和5-Fr Cook心包导管进行钝性解剖(图D;在线补充数据,视频S3)。去除了大约300 cc的出血液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。搅动的盐水最初填充一个位置(在线补充数据,视频S2),并逐渐膨胀,因为使用0.35英寸导丝和5-Fr Cook心包导管进行钝性解剖(图D;在线补充数据,视频S3)。去除了大约300 cc的出血液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。视频S2)并随着使用0.35英寸导丝和5-Fr Cook心包导管进行的钝性解剖而逐渐扩展(面板D;在线补充数据补充数据,视频S3)。去除了大约300 cc的出血液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。视频S2)并随着使用0.35英寸导丝和5-Fr Cook心包导管进行的钝性解剖而逐渐扩展(面板D;在线补充数据补充数据,视频S3)。去除了大约300 cc的出血液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。重复TTE显示右心房和心室附近的积液消失,但左心室后方持续出现中度定位积液(图E和F,星号)。再次进行心包穿刺术时,再次进行钝器解剖,并去除220 cc恶性细胞阴性的出血性液体,完全消除了积液。
更新日期:2020-03-19
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