Extensive Pericardial Metastasis of Angiosarcoma: Diagnostic Challenge in a Young Case With Effusive Constrictive Pericarditis

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Tatsunori Takahashi MD , Debbie Lin Teodorescu MD , Wyleen Kniola MD , Daniel Luthringer MD , Siddharth Singh MD
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Abstract

A 32-year-old healthy man developed a small pericardial effusion following a motor vehicle accident, which progressed to cardiac tamponade and bilateral pleural effusions over 2 months. Pericardiocentesis drained 1.5 L of hemorrhagic, lymphocyte-predominant exudative fluid, leading to symptomatic improvement and close outpatient follow-up for suspected postcardiac injury syndrome. However, he was readmitted 1.5 months later with recurrent effusions, mediastinal lymphadenopathy, and enlarging hepatic lesions, but without elevated inflammatory markers. Extensive analyses of various fluids, including expert-reviewed cytology and immunostaining, were inconclusive. Despite conservative management, worsening respiratory failure and persistent high chest tube output necessitated venovenous extracorporeal membrane oxygenation. Suspected constrictive pericarditis on transthoracic echocardiography led to the patient's transfer to our quaternary-care hospital for evaluation for pericardiectomy. However, pericardiectomy was deferred due to his unstable respiratory status. Despite intensive care, he eventually died of multiorgan failure 7 months after his initial presentation. Autopsy revealed high-grade hepatic angiosarcoma metastatic to lungs and pericardium with diffuse invasion into the myocardium. This case highlights the importance of cautious interpretation of negative cytology results in patients with recurrent hemorrhagic pericardial effusion, especially without elevated inflammatory markers. When clinical exclusion of pericardial malignancy is challenging, early multidisciplinary consideration of pericardial biopsy may be considered to enhance the diagnostic yield and guide management.
血管肉瘤广泛的心包转移:一例年轻的渗出性缩窄性心包炎的诊断挑战。
一位32岁的健康男性在一次机动车事故后出现少量心包积液,两个多月后发展为心包填塞和双侧胸腔积液。心包穿刺排出1.5L出血性、淋巴细胞为主的渗出液,导致症状改善,对疑似心后损伤综合征进行密切门诊随访。然而,他在1.5个月后再次入院,反复出现积液、纵隔淋巴结病和肝脏病变扩大,但没有炎症标志物升高。对各种液体的广泛分析,包括专家审查的细胞学和免疫染色,都没有定论。尽管保守治疗,恶化的呼吸衰竭和持续高胸管输出量需要静脉-静脉体外膜氧合。经胸超声心动图显示疑似缩窄性心包炎,导致患者转至我们的四级护理医院评估心包切除术。然而,由于他的呼吸状态不稳定,心包切除术被推迟。尽管经过精心护理,他最终在最初的表现七个月后死于多器官衰竭。尸检显示高级别肝血管肉瘤转移至肺和心包膜并弥漫性侵入心肌。本病例强调了谨慎解释反复出血性心包积液患者的阴性细胞学结果的重要性,特别是没有升高的炎症标志物。当临床排除心包恶性肿瘤具有挑战性时,可以考虑早期多学科的心包活检,以提高诊断率和指导治疗。
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来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
期刊介绍: Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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