A Rare Case of Effusive Constrictive Cholesterol Pericarditis: A Case Report and Review

Adamson, Van W.; Slim, Jennifer N.; Leclerc, Kenneth M.; Slim, Ahmad

doi:10.1155/2013/439505

Cited by 6 publications

(11 citation statements)

References 3 publications

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“…In 49% of cases, CP tends to be idiopathic, whilst other cases have been attributed to RA, tuberculosis, and hypothyroidism. 4 , 5 Less commonly associations exist with renal polycytosis, heart failure, myocardial infarction and metastatic carcinomas. 4 , 5 In our clinical case, no evidence of malignancy was identified; making his RA, although quiescent the most likely underlying aetiology.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 5 Less commonly associations exist with renal polycytosis, heart failure, myocardial infarction and metastatic carcinomas. 4 , 5 In our clinical case, no evidence of malignancy was identified; making his RA, although quiescent the most likely underlying aetiology. A diagnostic aid in CP is the finding of pericardial fluid cholesterol levels greater than 1.8 mmol/L; significantly more than standard 0.5–1 mmol/L with associated cholesterol crystal formation on microscopy.…”

Section: Discussionmentioning

confidence: 99%

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Effusive-constrictive cholesterol pericarditis: a case report

Shergill

Davies

Cairns

2020

European Heart Journal - Case Reports

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Background Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism. Case summary We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrence of the effusion with pericardial thickening and progressive constriction. He remained asymptomatic and underwent a successful pericardial window. At present, he is under close clinical outpatient surveillance with symptoms guiding a future pericardiectomy if warranted. Discussion CP can present as an emergent situation with signs and symptoms of acute heart failure with prompt pericardiocentesis required in cases of clinical tamponade. However, the disease course is often one of chronicity with relapsing large effusions that tend to recur following drainage, with the development of pericardial constriction necessitating pericardiectomy for definitive management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effusive-constrictive cholesterol pericarditis: a case report

Shergill

Davies

Cairns

2020

European Heart Journal - Case Reports

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“…Symptomatic pericarditis is associated with higher mortality in patients with RA [ 3 , 5 ]. Additional pericardial manifestations of RA include cholesterol pericarditis [ 6 , 7 ], effusive-constrictive pericarditis [ 8 , 9 ], and cardiac tamponade [ 10 , 11 ]. These have been described in newly diagnosed cases as well as long-standing RA.…”

Section: Discussionmentioning

confidence: 99%

Chest Pain Due to Pericardial Effusion as Initial Presenting Feature of Rheumatoid Arthritis: Case Report and Review of the Literature

et al. 2017

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Pericardial effusions are not uncommon in rheumatoid arthritis (RA); however, they are rarely the presenting symptom of the disease. We describe a 55-year-old female who presented to the emergency department with complaints of chest pain and dyspnea on exertion. Initial workup revealed a medium-sized pericardial effusion. The wide spectrum of etiologies, including infectious and non-infectious disease, was explored. Eventually, after ruling out an array of disease states, rheumatologic workup was positive for RA. The initial presentation in our case was atypical due to absence of small joint polyarthritis and other common symptoms of RA. In difficult cases, extensive workup including laboratory tests, electrocardiography, echocardiography and imaging studies can aid in narrowing the causes of pericardial effusion. This case demonstrates that pericardial effusion could be an early presenting feature of RA, even in the absence of more common symptoms, and should be considered in differential diagnosis.

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“…14 Treatment of the pericarditis associated with hypothyroidism is based on case reports and cohort data. [15][16][17][18] Patients are treated with thyroid replacement therapy and are also treated for pericarditis with ASA/NSAIDs, colchicine, and/ or corticosteroid therapy. 12 High-dose anti-inflammatory therapy should be initiated in patients with pericarditis, especially those with pleuritic chest pain.…”

Section: Hypothyroidism-induced Pericarditismentioning

confidence: 99%

Pharmacotherapeutic Management Strategies for Thyroid Disease–Induced Pericarditis

Schwier

O’Neal

2019

Ann Pharmacother

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Objective: To describe the various pharmacotherapeutic strategies in managing thyroid disease-induced pericarditis (TDIP). Considerations for both hypothyroid-induced and hyperthyroid-induced pericarditis will be discussed. Data Sources: A literature search of MEDLINE, including PubMed, was performed inclusive of all years, using the following search terms: thyroid disease, pericardial diseases, pericarditis, acute pericarditis, cholesterol pericarditis, hypothyroidism, hyperthyroidism, colchicine, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, methimazole, propylthiouracil, and P-glycoprotein. Product monographs were reviewed as well. Study Selection and Data Extraction: Relevant English-language studies and data as well as the most current guidelines for diagnosis and management of thyroid and pericardial diseases were considered. Because of limited data regarding the subject matter, no date range limits were established during literature search. Data Synthesis: It is well documented that thyroid dysfunction can adversely affect cardiovascular function. Additionally, there are published guidelines on the diagnosis and management of pericarditis and, separately, thyroid disease. There are limited data, however, on managing TDIP. The sequela of untreated TDIP can be detrimental. Relevance to Patient Care and Clinical Practice: Strategies on managing TDIP are scarcely reported in the literature. This review provides clinicians with a single reference source for treatment strategies toward managing hypothyroidism-induced and hyperthyroidism-induced pericarditis as well as significant drug interactions that can potentially confound the management of hypothyroidism- and hyperthyroidism-induced pericarditis. Conclusions: Treatment of TDIP involves addressing both the thyroid disease as well as the pericarditis. Along with treatment strategies, clinicians should also consider potential drug-drug and drug-disease interactions that can potentially worsen clinical outcomes.

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A Rare Case of Effusive Constrictive Cholesterol Pericarditis: A Case Report and Review

Cited by 6 publications

References 3 publications

Effusive-constrictive cholesterol pericarditis: a case report

Effusive-constrictive cholesterol pericarditis: a case report

Chest Pain Due to Pericardial Effusion as Initial Presenting Feature of Rheumatoid Arthritis: Case Report and Review of the Literature

Pharmacotherapeutic Management Strategies for Thyroid Disease–Induced Pericarditis

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