Ayala Torres Juan D, Gómez Salazar Santiago Andrés, Vélez Zuluaga Juan Gonzalo
Radiology, Universidad de Antioquia, Medellín, COL.
Radiology, Pablo Tobón Uribe, Medellín, COL.
Cureus. 2024 Mar 17;16(3):e56339. doi: 10.7759/cureus.56339. eCollection 2024 Mar.
The presented case describes a 56-year-old male with adult-onset Still's disease, exhibiting polyserositis in 2019, who underwent pleurectomy and pericardiectomy. Despite treatment with tocilizumab and methylprednisolone, the patient developed deep vein thrombosis and pulmonary embolism in 2022, managed with apixaban. A contrast-enhanced chest tomography revealed no recurrent thromboembolic events. Over a year, the patient experienced progressive dyspnea, correlating with signs of constriction on transthoracic echocardiogram. Cardiac magnetic resonance imaging confirmed cardiac herniation, prompting pericardiectomy. Surgery led to complete resolution of anatomical alterations without heart failure or new abnormalities, although exertional dyspnea persists post-discharge. The pathophysiology of cardiac herniation involves complex mechanisms influenced by congenital or acquired factors, resulting in abnormal heart protrusion. Medical literature highlights varied presentations, with acute cases typically post-thoracic surgeries, while late-onset cases are less common. Imaging modalities like computed tomography (CT) and cardiac magnetic resonance (CMR) aid diagnosis, emphasizing interdisciplinary collaboration. Despite challenges posed by its rarity, timely diagnosis and treatment are crucial for favourable outcomes, demonstrating the importance of considering this entity in clinical practice.
本病例介绍了一名56岁成年起病的斯蒂尔病男性患者，于2019年出现多浆膜炎，接受了胸膜切除术和心包切除术。尽管使用托珠单抗和甲泼尼龙进行了治疗，但患者在2022年发生了深静脉血栓形成和肺栓塞，采用阿哌沙班进行治疗。对比增强胸部断层扫描显示没有复发性血栓栓塞事件。在一年多的时间里，患者出现进行性呼吸困难，与经胸超声心动图显示的缩窄迹象相关。心脏磁共振成像证实了心脏疝，促使进行心包切除术。手术使解剖结构改变完全缓解，未出现心力衰竭或新的异常情况，尽管出院后运动性呼吸困难仍然存在。心脏疝的病理生理学涉及受先天性或后天性因素影响的复杂机制，导致心脏异常突出。医学文献强调了其表现形式多样，急性病例通常发生在胸外科手术后，而迟发性病例则较少见。计算机断层扫描（CT）和心脏磁共振（CMR）等成像方式有助于诊断，强调多学科协作。尽管因其罕见性带来了挑战，但及时诊断和治疗对于取得良好结果至关重要，这表明在临床实践中考虑这一疾病实体的重要性。
