Iwata Tomohiko, Murata Mitsunobu, Hirose Masahiro, Shimada Kazuyuki
Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical School, Tochigi.
J Cardiol. 2006 Oct;48(4):221-6.
A 72-year-old man with no symptoms was admitted to our hospital to investigate increased cardiothoracic ratio on chest radiography. There were no specific physical findings but the cardiac sound was weak. Electrocardiography showed low voltage in all leads. Thyroid function was within normal limits. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was performed, and 1,800ml of gold paint-like opaque fluid was drained. Microscopic examination revealed cholesterol crystals, so the diagnosis was cholesterol pericarditis. Cytologic examination revealed no malignant cells, and no bacteria was cultured. Mycobacterium tuberculosis was not amplified using the polymerase chain reaction method of pericardial fluid. Further analysis showed reduction of apo-B in the pericardial fluid, suggesting involvement in the precipitation of cholesterol.
一名72岁无症状男性因胸部X线检查发现心胸比率增加而入住我院。体格检查无特殊发现，但心音较弱。心电图显示各导联低电压。甲状腺功能正常。超声心动图显示大量心包积液。进行了心包穿刺，抽出1800毫升金色漆样不透明液体。显微镜检查发现胆固醇结晶，因此诊断为胆固醇性心包炎。细胞学检查未发现恶性细胞，也未培养出细菌。采用心包液聚合酶链反应法未扩增出结核分枝杆菌。进一步分析显示心包液中载脂蛋白B减少，提示其参与了胆固醇的沉淀。
