Department of Research Ward, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
J Int Med Res. 2020 Nov;48(11):300060520973091. doi: 10.1177/0300060520973091.
Chronic massive pericardial effusion without cardiac tamponade is relatively rare. Nearly half of all patients with chronic large pericardial effusion are asymptomatic. We report a case of a 77-year-old man who presented with an asymptomatic chronic massive pericardial effusion, with no evidence of cardiac tamponade or pericardial constriction during a 10-year follow-up. The patient had a complex history of lymph node tuberculosis, hypertension, hypothyroidism, and polycythemia vera, as well as high-dose P radiation exposure 45 years ago. There was no evidence of tuberculosis infection, hypothyroidism, malignant tumor, severe heart failure, uremia, trauma, severe bacterial or fungal infection, chronic myeloid leukemia, or bone marrow fibrosis after admission. The patient underwent pericardiocentesis twice. The pericardial effusion comprised exudate fluid with a high proportion of monocytes. The patient refused indwelling catheter drainage or pericardiectomy. The likely final diagnosis was recurrent chronic large idiopathic pericardial effusion.
慢性大量心包积液无心脏压塞相对少见。近一半的慢性大量心包积液患者无症状。我们报告了一例 77 岁男性病例，该患者在 10 年随访期间无症状的慢性大量心包积液，无心脏压塞或心包缩窄的证据。该患者有复杂的淋巴结结核、高血压、甲状腺功能减退、真性红细胞增多症病史，以及 45 年前接受过高剂量 P 射线照射。入院后无结核感染、甲状腺功能减退、恶性肿瘤、严重心力衰竭、尿毒症、创伤、严重细菌或真菌感染、慢性髓系白血病或骨髓纤维化的证据。患者接受了两次心包穿刺术。心包积液为渗出液，单核细胞比例高。患者拒绝留置导管引流或心包切除术。可能的最终诊断是复发性慢性特发性大量心包积液。
