(Circulation. 2000;101:e196.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Acute Cardiac Tamponade Caused by Massive Hemorrhage From Pericardial Cyst
From the Division of Pediatrics (I.S., A.K., Y.Y., K.H.) and the Division of Pediatric Cardiovascular Surgery (M.Y.), Children’s Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Introduction |
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 Top Introduction |
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A12-year-old girl with no significant previous cardiac history was transferred to our university hospital because of 1 week of high fever and dyspnea. On physical examination, the heart sounds were muffled, the heart rate was 110 bpm, the respiratory rate was 32 breaths per minute with dyspnea, and the blood pressure was 110/75 mm Hg. A chest radiograph revealed marked cardiac enlargement (Figure
, A). A CT demonstrated multiple
cystic structures in the pericardial cavity, which were slightly
enhanced by contrast medium (B). 2D
echocardiography exhibited massive pericardial
effusion with multiple moving cystic structures near the left atrial
appendage and the apex (C and D). Because percutaneous
needle aspiration yielded bloody pericardial fluid, massive
hemorrhage from the cystic tissue was suspected. Three hours
after admission, the patient’s blood pressure had fallen to 74/46
mm Hg. An emergency drainage and resection of the abnormal tissues was
undertaken by median thoracotomy. Approximately 1000 mL of bloody fluid
was aspirated from the pericardial cavity. Several blood-containing
cysts with extracystic hemorrhage were found near the left
atrial appendage, and 2 yellowish cysts were also found near the apex
(E). These cysts attached to a peduncle that originated from the
posterior wall of the pericardial cavity near the right bronchus and
ran down to the apex via the left atrial appendage. The total abnormal
tissue was almost completely resected from the adherent neighboring
tissues. Microscopic examination showed that the cyst wall consisted of
a vascularized, fibrous connective tissue and a single layer of
mesothelial cells (F). In some areas of the cysts,
polymorphonuclear leukocytes were seen, indicative of an
inflammatory process. Culture of the pericardial effusion was negative.
No evidence of malignancy was noted. The pathological diagnosis
confirmed pedunculated and hemorrhagic pericardial cysts. The
patient’s postoperative course was uneventful. During a 10-month
follow-up, she has had no sign of constrictive
pericarditis.
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Footnotes |
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Reprint requests to Isao Shiraishi, MD, Division of Pediatrics, Children’s Research Hospital, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamikyo-ku, Kyoto, Japan 602-8566.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation editorial office, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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