- Email: [email protected]
PP-314 Massive Pericardial Effusion due to Intrapericardial Mixed GermCell Tumor in a Premature Baby: A Case Report
MARCH 13e16, 2014 and back pain. Her first laboratory results were as follows: white blood cell 13,6 x103 per microliter; hematocrit 39,6 %, platelets 389 x103 per microliter; troponin I 10,71 ng/mL (N <¼ 0.04 ng/mL). The result of admission electrocardiogram (ECG) was normal except sinus tachycardia. Morhine low dose was used to stop her pain. Initial echocardiography demonstrated impaired left ventricle (LVEF 35%, calculated by modified Simpson method), with global left ventricular wall hypokinesia. Mitral regurgitation was mild. On day 2 of admission, troponin I concentration decreased to 2,4 ng/mL and 0,39 ng/mL on day 4. There was no ECG change. The patient was put on digoxin tb, perindopril 5 mg tb per day and furosemide 10 mg per day. She was discharged from the hospital after 5 days of hospitalization. One weeks after her discharge, echocardiography showed progressive improving LV function of 60% with normal-sized ventricles and no hypokinesia. Conclusion: Myocardial involvement after a spider bite is rare and can be fatal. In regions endemic with Latrodectus spiders, prudent treatment of spider bites may include cardiac evaluation and monitoring. When a Latrodectus bite is suspected, ECG, cardiac enzymes follow-up and echocardiography for symptomatic patients should be considered for the early detection of cardiac involvement in the patients envenomated by BWS.
- PP-314 Massive Pericardial Effusion due to Intrapericardial Mixed GermCell Tumor in a Premature Baby: A Case Report. Ö. Doksöz1, D.T. Terek2, M. Karaçelik3, H.T. Yıldırım4, M. Küçük1, D. Gönülal2, Ö. Olukman2, S. Arslanoglu2, T. Mes¸e1, O.N. Sarıosmano glu3, N. Ünal1. 1Izmir Dr. Behcet Uz Children’s Hospital, Department of Pediatric Cardiology, Izmir/Turkey; 2Izmir Dr. Behcet Uz Children’s Hospital, Department of Neonatology, Izmir/Tukey; 3Izmir Dr. Behcet Uz Children’s Hospital, Department of Cardiovascular Surgery, Izmir/Turkey; 4Izmir Dr. Behcet Uz Children’s Hospital, Department of Pathology, Izmir/Turkey.
P O S T E R A B S T R A C T S
Introduction: Germ cell tumors are rare tumors of childhood representing only 1% to 3% of childhood tumors. Twenty percent of germ cell tumors are malignant, related with age and location. Extragonadal sites account in nearly half of the patients where as adult form only in % 10. Yolk sac tumor in which alpha fetoprotein (AFP) is the marker of the disease is the most seen malignant histology. We present a premature baby of twins with hydrops fetalis having intrapericardially located mixed germ cell tumor. Case: A male appropriate for gestational age premature twin baby was born after 33 weeks of gestation with hydrops fetalis that was detected during routine ultrasound follow-up. The telecardiogram revealed a wall to wall cardiac silhouette. Echocardiography showed
Figure 1. (A) Echocardiography showed massive pericardial effusion, solid and multicystic (arrows) anterior placement intrapericardial mass; adjacent to the right atrium and vena cava superior, (B) Mass is adherent to ascending aorta.
massive pericardial effusion with heterogeneous solid and multicystic 40x35 mm intrapericardial mass. Although it was adherent to ascending aorta, didn’t cause any obstruction to caval system (Figure 1). Otherwise cardiac structures and functions were normal except patent foramen ovale. Diagnostic and therapeutic pericardiocentesis was performed and 55 ml of serohemoragic pericardial fluid was taken. The fluid was consistent with exudates nature. Although cytopathological examination revealed numerous red blood cells no malign cells were detected. Alfa fetoprotein level was 62576 ng/mL (N: 0.0-7.0) and beta human chorionic gonadotropin (beta hCG) level was 1.1 mIU/mL (N: 0.0-5.0). With median sternotomy an encapsulated 6x5 cm sized, extracardiac tumor was removed. Post surgical recovery was uneventful except minimal pericardial effusion. Alfa fetoprotein level fell to 14048 ng/mL, two days after the operation. The specimen was lobulated and 6x4.5x2.5 cm in size. Pathological macroscopic examination revealed solid gray-white areas with small cystic formations with mixoid liquid inside were seen. Microscopically; although mature teratoma was seen in most of the microscopic sections; immature fields were detected in some areas. Yolc sac component was seen in only one section among numerous samples and sections, it was stained strongly positive by AFP and alfa-1 antitrypsine and weakly positive with pancreatine and beta hCG. Finally, the diagnosis was mixed germ cell tumor. The first cure of chemotherapy which contain etiposid, cisplatinium and ifosfamide is given. In follow-up there were no pericardial effusion and any residuel mass. Conclusion: Primary cardiac tumors are uncommon in childhood, with an incidence of 0.06% to 0.32% fortunately intrapericardial teratoma represents an exceptional rarity among these entities. Early fetal imaging with ultrasound and echocardiography are reliable tools in identifying these cardiac teratomas.
- PP-315 Pre-T ALL Presenting with Massive Pericardial Effusion: Case Report. R. Ozdemir, Y. Yozgat, C. Karadeniz, O. Doksoz, M. Kucuk, T. Mese, N. Unal. Izmir Dr. Behcet Uz Children’s Hospital, Department _ of Pediatric Cardiology, Izmir, Turkey. Background: Etiological perspective of paediatric pericardial efusions are mostly infectious origin and also connective tissue disorders, metabolic, neoplastic processes and postpericardiotomy syndrome is rarely seen entities. Generally clinically evident pericardial effusions are rare. Nowadays, unfortunately pericardial involvement is one of the frequently encountered symptom of pediatric malignancies. Method: A 7 year-old boy presented with complaints of cough and chest pain admitted to emergency department after seven days of getting antibiotics for URTI. He appears less toxic and has no signs of cardiac decompensation or signs of shock. There were no findings of respiratory distress. A moderate tachycardia according to his age (104/min) with normal body temperature was observed. Initial physical examination was normal except cardiac auscultation revealing heart sounds were hardly audible. The nature of the chest pain was dull. Sitting up and leaning forward did not reduce the pain. His chest x-ray showed global cardiomegaly with mediastinal enlargement. His ECG revealed sinus rhythm, without voltage reduction and ST-T wave abnormalities in leads. Result: Paediatric cardiology consultation with echocardiography revealed massive pericardial effusion 45 mm at systole and 37 mmat diastole and obivious right sided compression of cardiac chambers due to effusion. Pericardiocentesis for diagnostic and aiming the relief of cardiac pre-tamponade had 240ml of haemorrhagic fluid (nearly 2/3 of the effusion). Cytologic smears were stained with May-Grünwald-Giemsa revealed large amount of blastic cell formation. Other diagnostic procedures including microbial including tuberculosis and serologic and PCR surveys was normal. After cytological examination of the smears
S134 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster
- PP-314 Massive Pericardial Effusion due to Intrapericardial Mixed GermCell Tumor in a Premature Baby: A Case Report. Ö. Doksöz1, D.T. Terek2, M. Karaçelik3, H.T. Yıldırım4, M. Küçük1, D. Gönülal2, Ö. Olukman2, S. Arslanoglu2, T. Mes¸e1, O.N. Sarıosmano glu3, N. Ünal1. 1Izmir Dr. Behcet Uz Children’s Hospital, Department of Pediatric Cardiology, Izmir/Turkey; 2Izmir Dr. Behcet Uz Children’s Hospital, Department of Neonatology, Izmir/Tukey; 3Izmir Dr. Behcet Uz Children’s Hospital, Department of Cardiovascular Surgery, Izmir/Turkey; 4Izmir Dr. Behcet Uz Children’s Hospital, Department of Pathology, Izmir/Turkey.
P O S T E R A B S T R A C T S
Introduction: Germ cell tumors are rare tumors of childhood representing only 1% to 3% of childhood tumors. Twenty percent of germ cell tumors are malignant, related with age and location. Extragonadal sites account in nearly half of the patients where as adult form only in % 10. Yolk sac tumor in which alpha fetoprotein (AFP) is the marker of the disease is the most seen malignant histology. We present a premature baby of twins with hydrops fetalis having intrapericardially located mixed germ cell tumor. Case: A male appropriate for gestational age premature twin baby was born after 33 weeks of gestation with hydrops fetalis that was detected during routine ultrasound follow-up. The telecardiogram revealed a wall to wall cardiac silhouette. Echocardiography showed
Figure 1. (A) Echocardiography showed massive pericardial effusion, solid and multicystic (arrows) anterior placement intrapericardial mass; adjacent to the right atrium and vena cava superior, (B) Mass is adherent to ascending aorta.
massive pericardial effusion with heterogeneous solid and multicystic 40x35 mm intrapericardial mass. Although it was adherent to ascending aorta, didn’t cause any obstruction to caval system (Figure 1). Otherwise cardiac structures and functions were normal except patent foramen ovale. Diagnostic and therapeutic pericardiocentesis was performed and 55 ml of serohemoragic pericardial fluid was taken. The fluid was consistent with exudates nature. Although cytopathological examination revealed numerous red blood cells no malign cells were detected. Alfa fetoprotein level was 62576 ng/mL (N: 0.0-7.0) and beta human chorionic gonadotropin (beta hCG) level was 1.1 mIU/mL (N: 0.0-5.0). With median sternotomy an encapsulated 6x5 cm sized, extracardiac tumor was removed. Post surgical recovery was uneventful except minimal pericardial effusion. Alfa fetoprotein level fell to 14048 ng/mL, two days after the operation. The specimen was lobulated and 6x4.5x2.5 cm in size. Pathological macroscopic examination revealed solid gray-white areas with small cystic formations with mixoid liquid inside were seen. Microscopically; although mature teratoma was seen in most of the microscopic sections; immature fields were detected in some areas. Yolc sac component was seen in only one section among numerous samples and sections, it was stained strongly positive by AFP and alfa-1 antitrypsine and weakly positive with pancreatine and beta hCG. Finally, the diagnosis was mixed germ cell tumor. The first cure of chemotherapy which contain etiposid, cisplatinium and ifosfamide is given. In follow-up there were no pericardial effusion and any residuel mass. Conclusion: Primary cardiac tumors are uncommon in childhood, with an incidence of 0.06% to 0.32% fortunately intrapericardial teratoma represents an exceptional rarity among these entities. Early fetal imaging with ultrasound and echocardiography are reliable tools in identifying these cardiac teratomas.
- PP-315 Pre-T ALL Presenting with Massive Pericardial Effusion: Case Report. R. Ozdemir, Y. Yozgat, C. Karadeniz, O. Doksoz, M. Kucuk, T. Mese, N. Unal. Izmir Dr. Behcet Uz Children’s Hospital, Department _ of Pediatric Cardiology, Izmir, Turkey. Background: Etiological perspective of paediatric pericardial efusions are mostly infectious origin and also connective tissue disorders, metabolic, neoplastic processes and postpericardiotomy syndrome is rarely seen entities. Generally clinically evident pericardial effusions are rare. Nowadays, unfortunately pericardial involvement is one of the frequently encountered symptom of pediatric malignancies. Method: A 7 year-old boy presented with complaints of cough and chest pain admitted to emergency department after seven days of getting antibiotics for URTI. He appears less toxic and has no signs of cardiac decompensation or signs of shock. There were no findings of respiratory distress. A moderate tachycardia according to his age (104/min) with normal body temperature was observed. Initial physical examination was normal except cardiac auscultation revealing heart sounds were hardly audible. The nature of the chest pain was dull. Sitting up and leaning forward did not reduce the pain. His chest x-ray showed global cardiomegaly with mediastinal enlargement. His ECG revealed sinus rhythm, without voltage reduction and ST-T wave abnormalities in leads. Result: Paediatric cardiology consultation with echocardiography revealed massive pericardial effusion 45 mm at systole and 37 mmat diastole and obivious right sided compression of cardiac chambers due to effusion. Pericardiocentesis for diagnostic and aiming the relief of cardiac pre-tamponade had 240ml of haemorrhagic fluid (nearly 2/3 of the effusion). Cytologic smears were stained with May-Grünwald-Giemsa revealed large amount of blastic cell formation. Other diagnostic procedures including microbial including tuberculosis and serologic and PCR surveys was normal. After cytological examination of the smears
S134 The American Journal of Cardiologyâ MARCH 13e16, 2014 10th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Poster