Lyuberetskaya District Hospital N2 (Head Physician - Smirnov VP)
Mesothelioma is defined as the primary tumor, more malignant course, has its source in the mesothelial cells of origin, members of the serous membranes of the pleura, peritoneum, pericardium.
Most mesothelioma is a rare localization of the pericardium. In most cases, secretion Mesothelioma has high capability that allows it to suspect if any hemorrhagic with recurrent pericarditis (after repeated punctures) effusion [11].
Histologically, there are three types of mesothelioma: fibrous - most benign type, epithelial and mixed. Metastasizing tumor infrequently and, in the case of timely diagnosis may cure by radical perikardektomii [4,14].
In this regard, the description of the individual observations is of great practical interest for potential in vivo diagnosis.
In 1981, 140 reported sightings of mesothelioma of them - 40 cases in the domestic literature [13]. For 15 years we have managed to find more than twenty observations described pericardial mesothelioma [1-6,8-14], and only in some cases [2,3,6,7,14] disease detected in vivo.
Clinical manifestations of pericardial mesothelioma can be different. Thus, according to one [11] tracked all eight cases of mesothelioma had clinical signs of bronchogenic lung cancer. Typical also considered manifestations of pulmonary pathology with the rapid development of pulmonary disease [3,6,9,12,13]. According to most authors, pericardium mesothelioma patients most often regarded as suffering from exudative hemorrhagic pericarditis.
Give their own observation
Patient B., 36 years old, a kindergarten teacher, was admitted to Liuberetskii NRB 30.09.1986, complaining of severe weakness, nausea, feeling outages heart. Of history - considers herself a patient 07.30.86, when suddenly lost consciousness, was treated in a regional hospital of the city of Kaluga. Due to the presence of pericardial friction noise, rhythm disorders were diagnosed infectious-allergic mioperikardit. She was treated with prednisone - 35 mg, Voltaren, ritmilenom. Further deterioration occurred after transferred angina - 9/30/86, when under physical load developed asthma attack, accompanied by severe weakness, fever, profuse sweat, marked hypotension. When you receive - condition was extremely grave. Food increased. Pale skin, cold to the touch. Moon face, lips cyanosis, acrocyanosis. Peripheral lymph nodes were not enlarged. The thyroid gland is not enlarged. Pronounced swelling shins. Above the surface of the lungs - vesicular breathing in the lower divisions on both sides - rales. Dyspnea - to 36 per minute. Visual area of the heart is not changed. Border of the relative cardiac dullness: right - 2 cm from the right edge of the sternum, upper - level III ribs, left - the anterior axillary line. Cardiac sounds dull, regular rhythm, heart rate - 104 in 1 min, blood pressure of 80/60 mm Hg Tongue clean, damp. Abdominal palpation soft and painless. The liver is enlarged to 4 cm beyond the costal arch on the right mid-clavicular line, the edge of her sharp, painful. Determined ascites. Negative sign of a beating from both sides. In the mind. Focal neurological symptoms and meningeal not. Clinical analysis of blood from 30/09/86, the hemoglobin - 110 g / l, leukocytes - 3.8 × 10 9 , EOZ. - 1 million p / - 6%, w / I - 74%, lymphocytes - 13%, monocytes - 6%, Anisocytosis weakly expressed shift towards macrocytosis. ESR - 23 mm / hour. On ECG - konkardantny ST-segment elevation in most leads. On radiographs of the chest - heart shadow extended across, waist heart smoothed. Echocardiography revealed the thickening of the pericardium, the presence of fluid in the cavity.
Diagnosed with pericardial effusion. He was treated with diuretics, antibiotics, antiarrhythmics - without significant effect. 1.10 - condition deteriorated - narosli shortness of breath, tachycardia, cyanosis, cold sweat, hypotension - 60/0 mmHg and, in spite of therapy, with increasing symptoms of heart failure, pulmonary edema, death occurred.
Clinical diagnosis.
Acute pericardial effusion of unknown origin. Cardiac tamponade. Myocarditis. NO circulatory failure. Extrasystolic arrhythmia.
At postmortem examination with subsequent histological doobsledovanii revealed isolated pericardial mesothelioma with obliteration of the cavity, the fibrous type. Bilateral hydrothorax, butternut liver, pulmonary edema, cerebral degenerative changes of the myocardium.
Feature of this case was the absence of one of the most characteristic features of mesothelioma-hemorrhagic exudative pericarditis.
Thus, this case is of interest as a diagnostic and tactically.
Conclusion: acute onset, showed symptoms of progressive heart failure, pericardial friction allowed noise with high probability diagnosis of pericarditis. ECG, echocardiography and X-ray examination confirmed the diagnosis of pericardial disease. Short finding sick in the hospital is not allowed to deepen the understanding of the etiology of pericarditis. According to the pathological-anatomical study verified the nature of pericardial disease - in the form of a rare type of fibrous mesothelioma, which led to the obliteration of the pericardial cavity, progressive cardiovascular disease, the corresponding picture of cardiac tamponade with a poor outcome. Feature of this case is the long latency for tumors of the pericardium, the absence of hemorrhagic fluid in the pericardial cavity - with a rare type of mesothelioma, pericardial fibrosis.
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http://medi.ru/doc/6690416.htm
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