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 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References
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CASE REPORT
Year : 1979  |  Volume : 25  |  Issue : 4  |  Page : 251-252

Pericardial effusion


Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India

Correspondence Address:
Lilam S Shah
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 529191

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 :: Abstract 

Detection of pericardial fluid by non-invasive ultrasonic techni­que is reported in a case of myxedema. Mediastinal swing and pseudo mitral valve prolapse are demonstrated. Equally increased thickness of the interventricular septum and left ventricular poste­rior wall may be due to myxedematous infiltrative changes.



How to cite this article:
Shah LS, Vengsarkar A S. Pericardial effusion. J Postgrad Med 1979;25:251-2

How to cite this URL:
Shah LS, Vengsarkar A S. Pericardial effusion. J Postgrad Med [serial online] 1979 [cited 2020 Dec 4];25:251-2. Available from: https://www.jpgmonline.com/text.asp?1979/25/4/251/42235



 :: Introduction Top


Since last decade ultrasonic studies have made it possible to detect pericar­dial effusion non-invasively. Edler [3] made the diagnosis of pericardial effusion for the first time from echocardiographic studies in 1955. Since 1965 various re­ports have been published. [1],[4],[5],[6],[7],[8],[10],[11] re­garding the detection of fluid and its quantitative assessment.


 :: Case report Top


M. P., a 45 year old male was admitted with puffiness of face, oedema of feet and distension of the abdomen. The patient was a known case of myxedema and had received thyroxine in the past. Systemic examination revealed features of myxedema. CVS examination sug­gested the presence of pericardial effusion.

His echocardiogram revealed an echo free space in the anterior and posterior pericardial sac. There was significant mediastinal flutter as suggested by wide excursion of the right ventricular endocardium, septum and mitral valve. Mitral valve also showed pesudo pro­lapse of the anterial mitral leaflet. (See [Figure 1] on page 250B).

Pericardial paracentesis was done. 800 ml of pericardial fluid was obtained. The colour of the pericardial fluid was golden yellow (gold paint effusion). Pericardial fluid choesterol was 173 mg per 100 ml and the blood choleste­rol was 250 mg per 100 ml.

Post-paracentesis echo showed loss of medias­tinal flutter; there was no echolucent space in the posterior and anterior pericardial sac. (See [Figure 2] on page 250B).

Identically increased thickness of interventri­cular septum and left ventricular posterior wall suggested symmetric cardiac hypertrophy, possibly infiltrative in nature (myxaedematous infiltration).


 :: Discussion Top


Detection of echolucent space in the anterior and posterior pericardial sac is diagnostic of pericardial effusion. With a significant accumulation of pericardial fluid, mediastinal swing is demonstrated as wide excursion of the right ventricu­lar endocardium, septum and the mitral valve. [9] D'Cruz et al [2] have reported an increase in the right ventricular dimen­sions and decrease in the left ventricular dimensions in cardiac tamponade during inspiration. Same authors [2] have reported inspiratory decrease of mitral valve EF slope; the diminution of mitral valve opening suggests a compromise of the left ventricular filling during inspiration Late systolic prolapse of the anterior mitral leaflet has been described by Lemire et al. [9] Our case presents these echocardiographic findings. Identical hypertrophy of the interventricular septum, lei ventricular posterior wall and slow hear rate are highly suggestive of myxedema.­

 
 :: References Top

1.Abbas, A. J., Ellis, N. and Flynn, J. J. Echocardiographic M. Scan technique is the diagnosis of pericardial effusion. JClin. Ultrasound, 1: 300-305, 1973.  Back to cited text no. 1    
2.D'Cruz, I. A., Cohen, H. C., Prabhu, F and Glick, G.: Diagnosis of cardiac tamponade by echocardiography. Changes in mitral valve motion and ventricular dimensions with special reference to paradoxis pulse. Circulation, 52: 460-465, 1975.  Back to cited text no. 2    
3.Edler, I.: The diagnostic use of ultra sound in heart diseases. Acta Med Scandinav., 152 (supplement 308): 32-36 1955.  Back to cited text no. 3    
4.Feigenbaum, H., Zaky, A., and Wald hausen J. A.: Use of reflected ultrasound in detecting pericardial effusion. Amer. J. Cardiol 19: 84-90 1967.  Back to cited text no. 4    
5.Feigenbaum, H., Zaky, A. and Grabhorn, L.: Cardiac motion in patients with pericardial effusion A study using ultra­sound cardiography. Circulation, 34: 611­619, 1966.  Back to cited text no. 5    
6.Feigenbaum, H.: Echocardiographic diag­nosis of pericardial effusion. Amer. J. Cardiol., 26: 475-479, 1970.  Back to cited text no. 6    
7.Goldberg, B. B., Ostrium, B. J. and Isard, H. J.: Ultrasonic determination of peri­cardial effusion. J. Amer. Med. Assoc., 202: 927-930, 1967.  Back to cited text no. 7    
8.Horowitz, M. S., Schultz, C. S. Stinson, E. B., Harrison, D. C. and Popp, R. L.: Sensitivity and specificity of echocardio­graphic diagnosis of pericardial effusion. Circulation, 50: 239-247, 1974.  Back to cited text no. 8    
9.Lemire, F., Tajik, A. J., Giuliani, E. R., Gau, G. T. and Schattenberg, T. T.: Further echocardiographic observation in pericardial effusion. Mayo Clin. Proc. 51: 13-18, 1976.  Back to cited text no. 9    
10.Levisman, J. A. and Abbasi, A. S.: Abnormal motion of the mitral valve with pericardial effusion. Pseudo prolapse of the mitral valve. Amer. Heart J., 91: 18-20, 1976.  Back to cited text no. 10    
11.Rothman, J., Chase, N. E., Kricheft H, Mayoral, K and Beranbaum, E. R.: Ul­tra sonic diagnosis of pericardial effusion.Circulation, 35: 358-364, 1967  Back to cited text no. 11    


    Figures

  [Figure 1], [Figure 2]



 

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