Acute and Critical Care

Cardiology
A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium: Jong Wook Beom, Yeekyoung Ko, Ki Yung Boo, Jae-Geun Lee, Joon Hyouk Choi, Seung-Jae Joo, Ji Hwan Moon, Su Wan Kim, Song-Yi Kim; Acute Crit Care. 2021;36(1):70-74. Published online October 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00234

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Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is lifethreatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

Citations

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A Rare Case of Primary Purulent Pericarditis Caused by Streptococcus constellatus
Medeinė Kapačinskaitė, Dovilė Gabartaitė, Agnė Šatrauskienė, Ieva Sakaitė, Vytė Valerija Maneikienė, Aleksejus Zorinas, Vilius Janušauskas
Medicina.2023; 59(1): 159. CrossRef
The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding
Magdalena Pilarczyk-Zurek, Izabela Sitkiewicz, Joanna Koziel
Frontiers in Microbiology.2022;[Epub] CrossRef
The effects of pneumopericardium during epicardial catheter ablation after dry pericardiocentesis on patients with ventricular arrhythmia
Qingyong Chen, Bosen Yang, Zhenggang Lai, Wen Yue, Qing Yang
Journal of Interventional Cardiac Electrophysiology.2022; 66(2): 373. CrossRef

Thoracic Surgery
Chemical Pleurodesis Using Viscum album Extract in Gorham’s Disease Complicated with Chylothorax: Suk Ju Cho, Su Wan Kim; Acute Crit Care. 2018;33(2):105-109. Published online December 30, 2016; DOI: https://doi.org/10.4266/acc.2016.00164

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Abstract PDF

Gorham’s disease, also known as massive osteolysis, is characterized by unregulated proliferation of lymphatic or vascular capillaries within bone, resulting in destruction and replacement with angiomatous tissue. This disease can lead to chylothorax that can be lethal. Viscum album extract from European mistletoe is a complementary anti-cancer drug which is commonly prescribed in many European countries and is considered as a new generation of chemical agent for pleurodesis. A 14-year-old girl presented with dyspnea and chest pain. She was diagnosed as Gorham’s disease who was definitively treated with Viscum album extract for chylothorax that was refractory to standard conservative management.

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Systematic analysis of mistletoe prescriptions in clinical studies
Henrike Staupe, Judith Buentzel, Christian Keinki, Jens Buentzel, Jutta Huebner
Journal of Cancer Research and Clinical Oncology.2023; 149(9): 5559. CrossRef

Cardiology
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea: Su Wan Kim, Seogjae Lee; Korean J Crit Care Med. 2014;29(2):123-125. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.123

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Abstract PDF: Isolated chylopericardium as a complication of cardiac surgery is very rare. Two cases of chylopericardium have been previously reported in Korea; both patients suffered from chylopericardium after a corrective cardiac surgery for a congenital heart disease such as atrial or ventricular septal defect. We report a case of chylopericardium in a 55-year-old mitral valve replacement patient. The reason for chylopericardium was unclear, but it might have been related with the damaged lymph nodes and blunt dissection of the thymus. While most chylopericardium cases require surgical intervention, we managed this chylopericardium case with a low-fat diet for 3 days.

Extracorporeal Membrane Oxygenation as a Rescue Therapy in a Patient with Non-Iatrogenic Massive Hemoptysis: Jong Hoo Lee, Su Wan Kim, Yee Hyung Kim; Korean J Crit Care Med. 2013;28(3):225-229.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.225

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Abstract PDF: Despite the advanced technologies of intensive care, massive hemoptysis can still cause death in a small subset of patients. Extracorporeal membrane oxygenation (ECMO) is expected to provide adequate gas exchange, to reduce ventilator-induced lung injuries, and to eventually improve outcomes in these patients. Also, the instability of vital signs due to hemoptysis makes it impossible to perform immediate interventional procedures such as embolization and resectional surgery. In these cases, ECMO may be instituted as a bridge therapy. Herein, we describe the detailed course of our case, with the hopes of helping physicians to decide when to initiate ECMO in patients with massive hemoptysis.

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