PDF(Pubmed)
Abstract：
Purulent pericarditis (PP) is a localized infection of the pericardial cavity with suppuration that can be life-threatening. Treatment for PP consists of pericardial drainage and antimicrobial therapy. Constrictive pericarditis (CP), a form of diastolic heart failure that arises because an inelastic thickened pericardium, is a possible related dreadful complication of PP. Several echocardiographic findings suggestive of CP have been reported, but some require measurements or are difficult to reproduce. This case report presents a simple echocardiographic finding that reflects the clinical course of transient CP (TCP). A 76-year-old Japanese man presented to our hospital with chest pain and dyspnea. He was diagnosed with PP caused by Streptococcus pyogenes and treated with pericardial drainage and benzylpenicillin. The response to the treatment of the infection was favorable, but subsequent echocardiography and cardiac catheterization revealed a CP complication. Treatment with colchicine and ibuprofen was initiated, with improvement in CP within three months. During CP, a restricted right ventricular (RV) motion and movement of the liver towards the heart were observed before other echocardiographic findings suggestive of CP. Furthermore, this echocardiographic finding disappeared and normalized as CP improved. In this case of TCP following PP, changes in the echocardiographic \"RV sliding\" sensitively reflected the clinical course of CP. This simple finding may indicate inflammation of the pericardium and could be useful for the diagnosis and follow-up of CP.
摘要：
化脓性心包炎（PP）是心包腔的局部感染，化脓可能危及生命。PP的治疗包括心包引流和抗菌治疗。缩窄性心包炎(CP),一种舒张性心力衰竭的形式，由于无弹性的心包增厚而引起，是PP的可能相关的可怕并发症。已经报道了一些提示CP的超声心动图发现，但有些需要测量或难以复制。此病例报告提供了一个简单的超声心动图发现，反映了短暂性CP（TCP）的临床过程。一名76岁的日本男子因胸痛和呼吸困难来到我们医院。他被诊断为化脓性链球菌引起的PP，并接受心包引流和苄青霉素治疗。对感染的治疗反应良好，但随后的超声心动图和心导管检查显示CP并发症。开始用秋水仙碱和布洛芬治疗，CP在三个月内改善。CP期间,在其他超声心动图检查结果提示CP之前,观察到右心室(RV)运动受限以及肝脏向心脏运动受限.此外，随着CP改善,这一超声心动图发现消失并恢复正常.在PP之后的TCP的这种情况下，超声心动图“RV滑动”的变化敏感地反映了CP的临床过程。这个简单的发现可能表明心包的炎症，并且可能对CP的诊断和随访有用。
