Clinical Cases: Pericardial disease39Diagnostic difficulties of a vasculitis caused by uncommon cardiovascular manifestation40Pericardial mass in a post-surgery mitral endocarditis patient41Focal constrictive pericarditis: multimodality imaging

Autor: A. P. Marques, László Kovács, Ágnes Séllei, Jesús Gallego, I Joao, Fj. Jimenez Barros, Z. Morvay, M. Janaky, Ac. Gomes, Paula Fazendas, Albert Varga, Mm. Chaparro Munoz, Mm. Martinez Quesada, K. Congo, B Illes, Susana Marta Almeida, Aj. Castro Fernandez, Hélder Pereira, G. Freire, Gergely Ágoston, Ag. Ferreira
Rok vydání: 2016
Předmět:
Zdroj: European Heart Journal – Cardiovascular Imaging. 17:ii1-ii2
ISSN: 2047-2412
2047-2404
Popis: 39 Diagnostic difficulties of a vasculitis caused by uncommon cardiovascular manifestation {#article-title-2} Although pericardial effusion is a common finding in the echocardiographic laboratory, in many of the cases the etiology remains unexplored. Sometimes, by careful investigation, a treatable condition can be diagnosed. A 68-year-old woman was admitted to our hospital with a one-year-long history of dyspnea on exertion, leg swelling and dull chest pain. The patient lost 30 kg of weight in a year. The year before, due to her difficulty with breathing, our patient spent a day in an emergency department, where a chest CT was performed, which described an intramural haematoma of the ascending aorta. In the same period, hoarseness occurred. The otorhinolaryngological examination diagnosed left-sided recurrent nerve paralysis. The patient history included bilateral cataract, however, after cataract extraction, the patient remained blind to the left eye. At evaluation, her erythrocyte sedimentation rate was 52 mm/hour, the six-minute walk test supported the decreased physical activity. Transthoracic echocardiography revealed dilated ascending aorta and moderate pericardial effusion. Transoesophageal echocardiography showed thickened ascending aortic wall and aortic arch. Chest CT-angiography confirmed the concentric thickening; however, the descending aorta was not affected. The autoimmune serology showed ANCA-positivity with markedly elevated proteinase 3. Coronary CT angiography revealed that the thickened aortic wall caused a 40% stenosis in the proximal part of the right coronary artery and found a thickening of the pulmonary trunk wall along with the pulmonary arteries. The carotid ultrasound depicted a mass around the central part of the right common carotid artery. These findings were suggestive of both large vessel vasculitides and granulomatosis with polyangiitis. The case was complicated by difficulties in the radiologic differentiation of the intramural haematoma and the aortic wall infiltration. The location of the vascular involvement made the biopsy technically impossible. The diagnostic dilemma was dissolved by an ophthalmologic examination, which revealed left-sided anterior ischemic optic neuropathy. Regarding the involvement of the great arteries, the patient’s age, and the ophthalmological complication, giant cell arteritis was diagnosed. After three months of therapy, control echocardiography showed no pericardial effusion, the patient began to gain weight and the chest pain disappeared. In spite of the rare occurrence of pericardial effusion and Ortner’s syndrome in giant cell arteritis, a precise evaluation can lead to the diagnosis and a specific therapy, by which the development of an aortic aneurysm rupture can be prevented. ![Figure][1] Abstract 39 Figure. # 40 Pericardial mass in a post-surgery mitral endocarditis patient {#article-title-3} Purulent pericarditis is a rare condition (
Databáze: OpenAIRE
Externí odkaz: