Purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex oncologic and cardiac history.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cameron Rattray, Mohamad Moughnyeh, Jibran Fateh, Michael Lee
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引用次数: 0

Abstract

Background: Hepatic-pericardial fistulas are extremely rare complications typically arising from hepatic abscesses, trauma, or invasive procedures. These fistulas can lead to clinical manifestations such as pericarditis, cardiac tamponade, and septic shock. We report a case of purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex cardiac and oncologic history.

Case presentation: A 76-year-old man with a history of pancreatic, renal cell and prostate cancer presented with acute chest pain and dyspnea. Initial investigations revealed a moderate pericardial effusion and a suspicious hepatic lesion. The patient developed cardiac tamponade and underwent emergency pericardiocentesis, draining 750 ml of purulent fluid. A CT-guided biopsy confirmed a hepatic abscess with fistulization to the pericardium. Despite antibiotic therapy and drainage procedures, the patient's condition deteriorated, resulting in septic shock and death.

Discussion: This case highlights the challenges in managing hepatic-pericardial fistulas, particularly in patients with significant comorbidities. Bacteroides fragilis was identified as the causative pathogen, which underscores the importance of timely identification and management of these rare infections. Early surgical intervention and targeted antibiotic therapy are critical, although prognosis remains poor in patients with compromised cardiovascular and respiratory status.

Conclusion: Hepatic-pericardial fistulas, though rare, should be considered in patients with unexplained pericarditis or septic shock, particularly in the presence of hepatic abscesses. Early recognition, multidisciplinary management, and individualized treatment are essential to improve outcomes.

有复杂肿瘤和心脏病史的患者继发于肝-心包瘘的化脓性心包炎和感染性休克。
背景:肝-心包瘘是极为罕见的并发症,通常由肝脓肿、创伤或侵入性手术引起。这些瘘管可导致心包炎、心包填塞和感染性休克等临床表现。我们报告一例化脓性心包炎和感染性休克继发于肝-心包瘘患者复杂的心脏和肿瘤病史。病例介绍:76岁男性,有胰腺、肾细胞癌和前列腺癌病史,急性胸痛和呼吸困难。初步调查显示有中度心包积液和可疑的肝脏病变。患者出现心包填塞,接受紧急心包穿刺,排出750毫升化脓性液体。ct引导下活检证实肝脓肿伴心包瘘管形成。尽管进行了抗生素治疗和引流手术,但患者病情恶化,导致感染性休克和死亡。讨论:本病例强调了处理肝-心包瘘的挑战,特别是在有显著合并症的患者中。脆弱拟杆菌被鉴定为致病病原体,这强调了及时发现和处理这些罕见感染的重要性。早期手术干预和靶向抗生素治疗至关重要,尽管心血管和呼吸状态受损的患者预后仍然很差。结论:肝-心包瘘虽然罕见,但在不明原因心包炎或感染性休克患者中应予以考虑,特别是在存在肝脓肿的情况下。早期识别、多学科管理和个体化治疗对改善预后至关重要。
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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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