Mediastinal debulking for a T-cell leukaemia/lymphoma presenting with cardiac tamponade

Moraitis, Sotirios; Agrafiotis, Apostolos C.; Marinos, Leonidas; Panagiotou, Ioannis; Sakellaridis, Timotheos; Tsakalakis, Christos; Poulakidas, Elias

doi:10.4081/monaldi.2019.1072

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surgical intervention such as tumour resection or debulking would be the best option for this patient. 6 , 12 , 13 A pericardiotomy could be performed to evacuate the pericardial effusion, and a tissue biopsy obtained at the same setting 19 However, this was not feasible in this case, due to the unavailability of cardiothoracic surgeon in our hospital. The second option was to treat the lymphoma with chemotherapy, provided the tissue diagnosis was obtained earlier.…”

Section: Discussionmentioning

confidence: 93%

Worsening cardiac tamponade after pericardiocentesis in a patient with anterior mediastinum mass: a case report

Adi

Fong

Ahmad

et al. 2022

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Mediastinal mass is an entity with variable pathology and clinical spectrum. Anterior mediastinal mass can result in severe symptoms due to involvement of surrounding vital structures such as the great vessels, trachea-bronchial tree, and heart. We highlight a case of cardiac tamponade in a patient with an anterior mediastinal mass that was paradoxically worsened after decompressive pericardiocentesis. A 21-year-old male presented to the emergency department (ED) with breathlessness and hypotension. Bedside focused cardiac ultrasound revealed cardiac tamponade which was made worse with an anterior mediastinal mass compressing the right heart chambers. The patient was intubated for respiratory failure, following which an ultrasound-guided pericardiocentesis was performed. Unexpectedly, his hemodynamic status worsened after aspiration of 1000 ml of pericardial fluid. A repeat focused cardiac ultrasound showed reduced pericardial effusion, but worsening of right heart chambers compression by the mediastinal mass. Re-expansion of the pericardium space with 600 ml of normal saline improved the patient’s vital signs, and reduced the right heart compression. CT was deferred due to the patient’s hemodynamic instability. Despite resuscitation with fluids and initiation of vasopressor, the patient’s condition deteriorated. He succumbed to his illness due to obstructive shock causing multi-organ failure. The autopsy showed a large anterior mediastinal mass, and histopathological examination confirmed the diagnosis of lymphoma. This case demonstrated the therapeutic challenges of managing a shock patient with anterior mediastinal mass, and massive pericardial effusion causing cardiac tamponade.

show abstract

Section: Discussionmentioning

confidence: 93%