Cardiothoracic Surgery: Cardiology and Cardiothoracic Surgery |

Water Bottle Heart and Dysfunctional Marrow FREE TO VIEW

Siva Sivakumar, MD; Salim Surani, MD
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Baystate Wing Hospital, East Longmeadow, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A50. doi:10.1016/j.chest.2016.02.053
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SESSION TITLE: Cardiology and Cardiothoracic Surgery

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Pericardial effusion associated with Myelodysplastic Syndrome (MDS) has been reported post chemotherapy or with infectious etiologies. We hereby report a case of pericardial effusion at the time of diagnosis of MDS.

CASE PRESENTATION: A 59-year-old male with hypertension and heavy tobacco use was admitted to hospital due to high fever, chronic cough and dyspnea for two weeks. Patient appeared chronically ill. Patient was tachycardic at 100 beats/min, respiratory rate of 30/min, BP 100/50mmHg and oxygen saturation of 95% on 2 liter nasal cannula. Physical examination was normal except for increased AP chest diameter. Cardiac sounds were normal. Chest X-ray showed cardiomegaly and hyperinflated lungs. Electrocardiogram was normal except for sinus tachycardia. EKG Voltage was normal. BNP was 271, WBC was 43000 per microliter, Hb was 8.9gm/dl and platelet count was 50000. TSH was normal as was coagulation profile. CT scan of chest revealed moderate pericardial effusion and emphysematous changes. Bone Marrow biopsy showed findings consistent with Myelodysplastic syndrome of refractory anemia with excess blast type. Echocardiogram showed normal ejection fraction with 1 cm posterior pericardial effusion without evidence of tamponade. Next day due to worsening of dyspnea and pulsus paradoxus patient underwent repeat echocardiogram, which showed worsening of pericardial effusion with evidence of tamponade. He underwent surgical pericardial window with improvement. Pericardial fluid showed hemorrhagic effusion with blasts. Patient was initiated on chemotherapy with Azacitidine. Subsequent improvement led to his discharge home.

DISCUSSION: Pericardial effusion associated with Myelodysplastic syndrome is uncommon. It has been reported after chemotherapy or with infectious etiology.1, 2 B Natriuretic peptide and NT-ProBNP are elevated in many cardiac conditions including systolic and diastolic CHF, myocardial diseases, and pericardial diseases. Our patient had normal BNP despite a large pericardial effusion. In approximately 26% of patients pericardial effusions are associated with low voltage in EKG. Though our patient had a large pericardial effusion, his EKG showed normal voltage.3

CONCLUSIONS: Although MDS is associated with pericardial effusion following chemotherapy, we could neither find evidence that it may be associated, at the time of diagnosis, with MDS, nor is there a case report of pericardial effusion with Azacitidine. Mechanism is uncertain, but may likely be due to serositis.

Reference #1: Perez Castrillon JL, et.al. Rev Clin Esp 1990; 187(6): 310-11.

Reference #2: Fernandez-sojo J, et al. Med Clin (Barc) 2014; 143(1):43-4.

Reference #3: Kudo Y, et. al. Chest 2003; 124(6): 2064-7.

DISCLOSURE: The following authors have nothing to disclose: Siva Sivakumar, Salim Surani

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