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Cardiovascular Disease |

Complicated Postcardiac Injury Syndrome Secondary to an Intracardiac Foreign Body

Dane Langsjoen, MD; Kipp Slicker, DO; Juan Sanchez, MD
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Scott and White, Temple, TX


Chest. 2014;146(4_MeetingAbstracts):98A. doi:10.1378/chest.1992294
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Abstract

SESSION TITLE: Cardiovascular Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We present the case of a 43 year old female with chest pain, pericarditis, pleural effusions, and an intracardiac foreign body with subsequent thrombus. This case highlights an unusual complication and an undescribed cause of post cardiac injury syndrome.

CASE PRESENTATION: Our patient’s course began 6 months prior to presentation following a varicose vein ablation. She had multiple hospital admissions over several months. Her symptoms included pleuritic chest pain, pleural effusions, leukocytosis and dyspnea. Initially, she was diagnosed with idopathic and recurrent pericarditis after negative ECGs, coronary angiogram, CTAs, and cardiac MRI. The patient was readmitted four months later to the pulmonary service with bilateral pleural effusions. A thoracentesis demonstrated an exudative effusion, and autoimmune and thyroid serologies were negative. A cardiac MRI showed a RA mass, 2.2 x 1.1 cm, anterior to a thin linear band of tissue extending into the RA. A TEE noted a mass in the RA at the tip of a guidewire or pacing lead near the superior lateral wall of the RA below the entrance of the SVC. (fig. 1) Cardiothoracic surgery excised a several centimeter plastic cannula with associated mass (fig.2). Intraoperatively, pericarditis, thickened pericardium, and a plastic cannula projecting through the RA appendage stuck in the pericardium were noted.

DISCUSSION: We have a 43 year old female presenting with recurrent chest pain, pericarditis, and pleural effusions with a RA mass secondary to an intracardiac foreign body. Many cases of foreign bodies have been described, but we feel this case is particularly interesting in presentation, echocardiography, and inability to be identify the object with CT or MRI. Of greater interest, is the serositis highlighting the described immunological response seen in PCIS. Typically, PCIS is seen following cardiothoracic surgery and less frequently myocardial infarctions. It is characterized by pleural and pericardial effusions (left sided, exudative, lymphocytic, bloody with a normal pH), pleuritic chest pain, fevers, and leukocytosis, which are seen here. A PubMed search demonstrated no cases associated with intracardiac foreign bodies.

CONCLUSIONS: This case brings attention to not only a very unusual presentation and diagnosis of an intracardiac foreign body but also provides a previously undescribed cause of PCIS. Given the number of intravascular procedures and cardiac procedures performed in modern medicine, it is important to appreciate all potential complications, which includes PCIS. The serositis is consistent with a complicated PCIS based on her symptoms, pleural fluid analyses, and exclusion of alternatives

Reference #1: Light, Richard W (2001). Pleural Effusions Following Cardiac Injury and Coronary Artery Bypass Graft Surgery. Seminars in Respiratory and Critical Care Medicine 22(6)

Reference #2: Stelzner TJ (1983) The pleuropulmonary manifestatins of the Postcardiac Injury Syndrome. Chest 8(4)

DISCLOSURE: The following authors have nothing to disclose: Dane Langsjoen, Kipp Slicker, Juan Sanchez

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