心包疾病的异质性表达:一例报告/系列

T. Paterick
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引用次数: 0

摘要

心包在各种疾病状态下可表现出不同的表型表现,如急性心包炎、渗出性缩窄性心包炎和缩窄性心包炎。心包炎症表型表达的多样性需要独特的临床和体格检查,并与特定的影像学特征相关。本研究旨在回顾正常的心包和心包疾病的变异,并讨论其临床表现、病因、诊断工具和治疗方法。病例系列:一个病例系列的三个病人不同的表型表达的心包疾病已经被描述。第一位患者出现胸腹疼痛3小时。心电图显示下外侧ST段抬高,这被解释为急性冠脉综合征。然而,冠状动脉造影显示无阻塞性冠状动脉疾病。血液检查和心导管穿刺后心电图证实心包炎。第二例患者心房扑动右侧的腔尖峡有消融术。手术后,患者出现心包填塞,需要心包穿刺。2个月后,患者出现心动过速、低血压、心包填塞;因此再次行心包穿刺术。第二次心包穿刺两年后,患者出现进行性呼吸困难。灌注显像显示前壁缺血,冠状动脉造影显示三支冠状动脉病变。在搭桥手术中,由于患者心包致密增厚,外科医生无法解剖右冠状动脉和旋冠状动脉。此外,ct扫描显示一纤维化心包(厚度:12mm)。第三名患者接受了乳腺癌的化疗和放疗,最终达到了无癌状态。然而,乳腺癌复发,患者接受了生物Optivo治疗,导致癌症缓解。几个月后,患者出现心悸、呼吸困难、腹部和腿部肿胀。此外,她的肌钙蛋白升高和心电图改变导致心导管插入正常冠状动脉,冠状动脉固定在致密、增厚的浆膜心包中。随后的超声心动图显示明显的缩窄性心包炎征象,心脏MRI显示心包膜密集增厚伴弥漫性晚期钆增强。结论:心包疾病的表型表达是一个谜,诊断具有挑战性。各种形式的心包疾病可能与急性冠状动脉综合征和急性/慢性心力衰竭相似。由于疾病的每个表型表现都是独特的,因此合理的线性方法被认为是准确诊断的必要条件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Heterogeneous Expressions of Pericardial Disease: A Case Report/Series
Introduction: The pericardium may have various phenotypic manifestations in assorted disease states, such as acute pericarditis, effusive constrictive pericarditis, and constrictive pericarditis. The variety in the phenotypic expressions of pericardial inflammation requires unique clinical and physical examinations and is associated with specific imaging features. The present study aimed to review the normal pericardium and variations of the pericardial disease based on the previously described cases and discuss the clinical manifestations, etiology, diagnostic tools, and treatment methods.Case Series: A case series of three patients with various phenotypic expressions of pericardial disease have been described. The first patient presented with chest and abdominal pain for three hours. Electrocardiography (ECG) revealed inferior-lateral ST elevation, which was interpreted as an acute coronary syndrome. However, coronary arteriography revealed no obstructive coronary artery disease. Blood tests and ECG post-cardiac catheterization confirmed pericarditis. The second patient had ablation of the cavotricuspid isthmus on the right side of the atrial flutter. After the procedure, the patient had cardiac tamponade and required pericardiocentesis. After two months, the patient presented with tachycardia and hypotension, as well as cardiac tamponade; therefore, pericardiocentesis was performed again. Two years after the second pericardiocentesis, the patient presented with progressive dyspnea. Perfusion imaging revealed anterior wall ischemia, and coronary arteriography revealed three-vessel coronary artery disease. During the bypass surgery, the surgeon was unable to dissect the right and circumflex coronary arteries due to the densely thickened pericardium of the patient. In addition, CT-scan revealed a fibrotic pericardium (thickness: 12 mm). The third patient received chemotherapy and radiation for breast cancer, which resulted in a cancer-free state. However, breast cancer was recurrent, and the patient received treatment with biological Optivo, resulting in cancer remission. After several months, the patient presented with palpitations, dyspnea, and abdominal and leg swelling. Moreover, she had elevated troponin and ECG changes leading to cardiac catheterization with normal coronaries, which were fixed in a dense, thickened serosal pericardium. Subsequent echocardiography revealed evident signs of constrictive pericarditis, and cardiac MRI showed a densely thickened pericardium with diffuse late gadolinium enhancement.Conclusion: The Phenotypic expressions of pericardial disease are enigmatic and challenging diagnostically. Various forms of pericardial disease may mimic acute coronary syndrome and acute/chronic heart failure. Since each phenotypic presentation of the disease is unique, a rational, linear approach is considered essential to the accurate diagnosis.
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