Emergency Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
Cardiovascular Department, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
Am J Emerg Med. 2018 Mar;36(3):524.e1-524.e6. doi: 10.1016/j.ajem.2017.11.047. Epub 2017 Nov 21.
Pericardial effusion of various sizes is a quite common clinical finding, while its progression to effusive-constrictive pericarditis occurs in about 1.4-14% of cases. Although available evidence on prevalence and prognosis of this rare pericardial syndrome is poor, apparently a considerable proportion of patients conservatively managed has a spontaneous resolution after several weeks. A 61-year-old female presented to our emergency department reporting fatigue, effort dyspnea and abdominal swelling. The echocardiography showed large pericardial effusion with initial hemodynamic impact, so she underwent a pericardiocentesis with drainage of 800-850cm of exudative fluid, on which diagnostic investigations were undertaken: possible viral and bacterial infections, medical conditions, iatrogenic causes, neoplastic and connective tissue diseases were all excluded. Despite empirical therapy with NSAIDs and colchicine, after about one week she had a recurrence of pericardial effusion and progressive development of constriction. Echocardiography performed after a few weeks of anti-inflammatory therapy showed resolution of constriction and PE, with clinical improvement. If progression of pericardial syndromes to a constrictive form is rarely described in literature, cases of transitory effusive-constrictive phase are even more uncommon, mainly reported during the evolution of pericardial effusion. According to the available data, risk of progression to a constrictive form is very low in case of idiopathic pericardial effusion. We report a case of large idiopathic subacute pericardial effusion, treated with pericardiocentesis and then evolved into an effusive-constrictive pericarditis. A prolonged anti-inflammatory treatment leads to complete resolution of pericardial syndrome without necessity of pericardiectomy.
各种大小的心包积液是一种相当常见的临床发现，而其进展为渗出性缩窄性心包炎的发生率约为 1.4-14%。尽管关于这种罕见的心包综合征的患病率和预后的现有证据较差，但显然相当一部分接受保守治疗的患者在数周后会自发缓解。一位 61 岁女性因疲劳、劳力性呼吸困难和腹部肿胀到我院急诊科就诊。超声心动图显示大量心包积液，最初对血液动力学有影响，因此她接受了心包穿刺术，引流了 800-850cm 的渗出液，并进行了诊断性检查：可能的病毒和细菌感染、医疗状况、医源性原因、肿瘤和结缔组织疾病均被排除。尽管使用 NSAIDs 和秋水仙碱进行了经验性治疗，但约一周后她再次出现心包积液，并逐渐出现缩窄。在抗炎治疗数周后进行的超声心动图显示缩窄和心包积液消退，临床症状改善。如果心包综合征进展为缩窄型在文献中很少描述，那么短暂的渗出性-缩窄性阶段的病例则更为罕见，主要在心包积液的演变过程中报告。根据现有数据，特发性心包积液进展为缩窄型的风险非常低。我们报告了一例大型特发性亚急性心包积液，经心包穿刺治疗后进展为渗出性缩窄性心包炎。延长抗炎治疗可使心包综合征完全缓解，无需心包切除术。
