Benacerraf A, Ziskind B, Thibaut F, Kanoui A, Charlier P, Albahary C
Nouv Presse Med. 1979 Nov 12;8(44):3613-6.
These cases represented 2.8% of the patients admitted for pericarditis during the same period. The cause of irradiation was a carcinoma of the breast in three cases and a carcinoma of the oesophagus in two cases. Acute forms of pericarditis occured 8 and 13 months after irradiations, and chronic forms after 1, 8 and 13 years. Three clinical forms were observed; two patients had an acute form; the first one with a slight effusion was easily cured, the second with cardiac tamponnade recovered after surgical evacuation, two others patients had a chronic latent effusion; after surgical evacuation, one recovered but the other one developped an occult constrictive pericarditis diagnosed by rapid volume expansion. The fifth case was a constrictive pericarditis which was effectively traited by pericardectomy. The difficulty of etiological diagnosis varies with the time and the amount of effusion. When the effusion is moderate the distinction must be made with an acute idiopathic pericarditis; when effusion is large the distinction must be made with a tuberculosis and specially a tumoral recurrence; in three cases pericardial biopsy was carried out and eliminated these diagnosises; lesions were similar: pericard was sclerous and little in cells, inflammatory signs were slight or absent. The postoperative prognosis in constrictive pericarditis may be agravated by associated myocardial lesions.
这些病例占同期因心包炎入院患者的2.8%。放疗原因3例为乳腺癌，2例为食管癌。急性心包炎分别在放疗后8个月和13个月出现，慢性心包炎在放疗后1年、8年和13年出现。观察到三种临床类型：2例为急性型，第一例有少量积液，很容易治愈，第二例有心包填塞，经手术引流后康复；另外2例有慢性隐匿性积液，手术引流后，1例康复，但另1例发展为隐匿性缩窄性心包炎，通过快速扩容得以诊断。第五例为缩窄性心包炎，通过心包切除术有效治疗。病因诊断的难度随积液时间和量的不同而变化。当积液量中等时，必须与急性特发性心包炎相鉴别；当积液量大时，必须与结核尤其是肿瘤复发相鉴别；3例进行了心包活检，排除了这些诊断；病变相似：心包硬化，细胞少，炎症征象轻微或无。缩窄性心包炎术后预后可能因合并心肌病变而加重。
