Acute and Critical Care

Case Reports

Cardiology
A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium: Jong Wook Beom, Yeekyoung Ko, Ki Yung Boo, Jae-Geun Lee, Joon Hyouk Choi, Seung-Jae Joo, Ji Hwan Moon, Su Wan Kim, Song-Yi Kim; Acute Crit Care. 2021;36(1):70-74. Published online October 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00234

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Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is lifethreatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

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A Rare Case of Primary Purulent Pericarditis Caused by Streptococcus constellatus
Medeinė Kapačinskaitė, Dovilė Gabartaitė, Agnė Šatrauskienė, Ieva Sakaitė, Vytė Valerija Maneikienė, Aleksejus Zorinas, Vilius Janušauskas
Medicina.2023; 59(1): 159. CrossRef
The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding
Magdalena Pilarczyk-Zurek, Izabela Sitkiewicz, Joanna Koziel
Frontiers in Microbiology.2022;[Epub] CrossRef
The effects of pneumopericardium during epicardial catheter ablation after dry pericardiocentesis on patients with ventricular arrhythmia
Qingyong Chen, Bosen Yang, Zhenggang Lai, Wen Yue, Qing Yang
Journal of Interventional Cardiac Electrophysiology.2022; 66(2): 373. CrossRef

Chylopericardial Tamponade in a Patient with Chylothorax after Pulmonary Lobectomy: Jin Sue Jeon, Ho Geol Ryu, Hannah Lee, Da Hye Yoo; Korean J Crit Care Med. 2013;28(4):327-330.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.327

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Abstract PDF

Chylopericardium is a very rare, yet potentially fatal, complication following intrathoracic surgery, and can further lead to other life-threatening complications such as cardiac tamponade. A 54-year-old female underwent right upper lobectomy for lung cancer. Chylothorax developed on the 2nd postoperative day, and was managed conservatively with dietary modification. On the 9th postoperative day, the patient suddenly developed hypotension and severe cardiac dysfunction requiring cardiopulmonary resuscitation followed by VA ECMO. Transthoracic echocardiography revealed a large amount of pericardial effusion. Prompt pericardiocentesis was performed and the aspirated fluid showed features of chyle. Thoracic duct ligation with pericardial window operation was performed because the daily amount of chyle drained did not decrease after 3 weeks. Here, we review etiologies and therapeutic options of chylopericardial tamponade following intrathoracic surgery, which should not be underestimated even when the patient seems to demonstrate a good recovery.

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A Case of Chylopericardium Caused by Chylous Pleural Effusion Inflow from a Damaged Pericardium during Operation for Right Lung Cancer
Masahiro MATSUNO, Kyo HIRAYAMA, Nobuo TSUNOOKA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(6): 868. CrossRef
A case of cardiac tamponade caused by chylopericardium after mediastinal lymph node dissection for recurrence of lung cancer
Shinsuke Kitazawa, Kojiro Nakaoka, Naohiro Kobayashi, Shinji Kikuchi, Yukinobu Goto, Yukio Sato
The Journal of the Japanese Association for Chest Surgery.2017; 31(2): 181. CrossRef
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea
Su Wan Kim, Seogjae Lee
Korean Journal of Critical Care Medicine.2014; 29(2): 123. CrossRef

Cardiac Tamponade Caused by Epigastric Acupuncture: A Case Report: Jong Kun Kim; Korean J Crit Care Med. 2011;26(4):281-284.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.281

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Abstract PDF

Acupuncture is considered a relatively safe procedure. However, there are serious adverse effects; neurological damage, pneumothorax, cardiac tamponade, serum hepatitis, bacterial and viral infections may occur. Cardiac tamponade is considered to be a rare adverse effect of acupuncture. In the following case, cardiac tamponade was caused by epigastric acupuncture. A 78-year-old male was admitted with a chief complaint of drowsy mentality and hypotension, suggesting a status of shock. He had received acupuncture therapy over epigastric area for gastric dyspepsia at a local oriental medical clinic. An abdominal CT scan and chest x-ray showed a hemopericardium. After receiving pericardiocentesis, his clinical condition improved immediately. He was short in stature and slender for his age. Chest x-ray and computed tomography showed cardiomegaly and pectus excavatum. A proper use of acupuncture by a skilled medical provider is essential to avoid serious complications.

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A Study on Korean Traditional Medicine Side Effects Cases Described in Domestic Western Medical Journals in the Past 10 Years
Myeong-hwa Lee, Byun-woo Son, Kyoung-min Kim, Soo-hyung Jeon, Young-kyun Kim
The Journal of Internal Korean Medicine.2018; 39(4): 686. CrossRef

A Case of Uremic Pericarditis and Cardiac Tamponade That Developed after Ethylene Glycol Poisoning: A Case Report: Ki Ju Kim, Jung Gil Park, Han Jun Ryu, Yeoun Su Jung, Sung Ho Kim, Bong Ryeol Lee, Byung Chun Jung, Hyun Jae Kang; Korean J Crit Care Med. 2010;25(3):176-181.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.176

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Abstract PDF

Ethylene glycol is commonly incorporated into automotive antifreeze agents and a variety of other commercial products. Ethylene glycol poisoning can cause life-threatening metabolic acidosis, cardiopulmonary failure, and renal failure that may be fatal. We present an unusual case of a patient who ingested a large amount of ethylene glycol for the purpose of suicide and developed multiorgan damage, including acute renal failure followed by uremic pericarditis and cardiac tamponade. This unusual complication was effectively managed with echocardiography-guided percutaneous pericardiocentesis and continuous catheter drainage for 3 days. After intensive hemodialysis and supportive care, the patient made a good recovery with near normal cardiac and renal function. Physicians should be aware of the possibility of acute pericarditis and cardiac tamponade in cases of acute renal failure caused by ethylene glycol poisoning.

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Deneysel Etilen Glikol Zehirlenmesi Oluşturulan Ratlarda Myokardiyal Etkilerin Araştırılması*,**
Burak DOĞAN, Vehbi GÜNEŞ
Erciyes Üniversitesi Veteriner Fakültesi Dergisi.2020; 17(3): 275. CrossRef

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