Pericardial mesothelioma 1
     Patients, male, 28 years old. As a result of recurrent chest pain, shortness of breath 3 months to June 13, 1996 admission. Physical examination: T 37.8 ℃, P 94 times / min, R 24 times / min, BP 15.5/10 kPa. Acute tolerance, semi-sitting and lying, Nuzhang jugular vein and trachea in the middle. Thoracic symmetry, and promote a little breathing. Apex beat did not touch the heart to the community to expand bilateral, heart rate 94 times / min, low heart sound blunt, remote, 3, 4 intercostal sternum left edge of hair-like smell and SM 3 / 6 grade, no conduction can touch odd vein. Laboratory: WBC 10.6 × 109 / L, N 0.8, L 0.14, RBC 4.3 × 1012 / L, Hb 132 g / L, HCT 0.334, PLT 442 × 109 / L; ALT 101.0 U / L, ALP 57.0 U / L, GGT 45.2 U / L, AST 130.0 U / L, CK 1 048.0 U / L, CK-MB 8.4 U / L, LDH 296.7 U / L; more than abnormalities not check. Electrocardiogram showed: sinus rhythm, alternating power; X-ray showed pericardial effusion; heart that color: pericardial effusion, chest, abdomen with fluid. Admission to the INH + RFP + PZA + SM quadruple anti-tuberculosis treatment + prednisone 30 mg / d and nutrition, support for the symptomatic treatment. No improvement in condition, chest pain, shortness of breath worsened in the June 18 trip pericardial puncture is not out of the dark red liquid condensate 110 mL, the results of that inspection effusion: the appearance of blood, WBC 4.0 × 109 / L, RBC 3.2 × 1012 / L, Hb 104 g / L; Rivalta test (+ + + +), Alb 37.5 g / L, AST 925.0 U / L, CK 3 350 U / L, LDH 2 275 U / L; cytology did not find cancer cells ; Tb-DNA PCR method check (-). After the symptoms of smoking Liquid eased, disable anti-TB treatment. However, repeated symptoms, the review show CDFI still pericardial effusion, and has separated. On July 3 to the treatment of thoracic surgery, the pericardium adhesion separation + pericardium drainage catheter, cardiac surgery see there are old black liquid 300 mL, apex, rear left ventricle, right ventricle in front of adhesion are cellulose, Epicardial obvious thickening, and separation of pericardial adhesions in the home at the end of drainage tube drainage. Drainage of pericardial effusion after a total of 120 mL. Pericardial biopsy: a number of positive changes in cellulose-like degeneration, some of the region and a small amount of bleeding in chronic inflammatory cell infiltration. Postoperative symptoms in hospital on July 30. Discharged from hospital after anti-TB treatment, patient follow-up visits on a regular basis and to be able to return to work. However, on September 7 in the recurrence of chest pain, shortness of breath, nausea, vomiting, sweating profusely and re-admitted. Heart color: no significant pericardial effusion, at the bottom of the left heart see strong echo-ray mission, irregular, about 8.6 cm × 7.2 cm, to the tumor. The next day progressive shortness of breath and increase the frequency of vomiting, heart rate 130 times / min, breathing 24 times / min, BP 11.5 / 7 kPa, by the arm, such as step-up treatment without improvement, the sudden appearance of limbs, convulsions, coma, with heart To stop breathing and died. Body pathology report: pericardial mesothelioma. On the heart, pericardium tumor is a rare disease, primary tumor autopsy found that about 1 / 2 000. The clinical performance of the heart tumor was non-specific, vulnerable to misdiagnosis. In the early onset of this case, only the performance of the bloody pericardial effusion, in the 1st hospital thoracotomy Bank separation surgery pericardial adhesions not yet found the tumor, according to tuberculosis after anti-TB + to hormone therapy, the disease must be to ease , It has been misdiagnosed, and more than 1 month after hospitalization when the heart tumor discovery color, the autopsy confirmed pericardial mesothelioma. Mesothelioma clinical occur in the pleura, the pericardium can be involved and the mediastinum, the primary pericardial mesothelioma is particularly rare. Pleural pleural mesothelioma for more blood, the proportion of high protein, high glucose and lower the pH value of the ordinary, hyaluronic acid and high levels of LDH. If the pleural effusion of hyaluronidase significantly increased, suggesting that malignant mesothelioma. This case, pericardial effusion change is in line with the characteristics of the pleural pleural mesothelioma, mesothelioma pericardial effusion that the characteristics of pleural mesothelioma and pleural effusion of the characteristics are the same, for the early diagnosis of the disease has provided the basis for more .