Limits...
Constrictive Pericarditis Long after a Gunshot Wound.

Choi JH, Uhm JS, Lee SE, Chun KH, Lee HJ, Lee SH, Hong GR, Lee MH - Korean Circ J (2015)

Bottom Line: Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium.Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period.The history of the patient revealed an injury by gunshot during the Korean War in 1950.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications.

No MeSH data available.


Related in: MedlinePlus

Pulsed-wave Doppler image reveals significant respiratory variation of the mitral inflow velocity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4521112&req=5

Figure 4: Pulsed-wave Doppler image reveals significant respiratory variation of the mitral inflow velocity.

Mentions: A 69-year-old man visited our hospital for palpitation and dyspnea on exertion. The symptoms began four months prior to his visit to the hospital. On physical examination, a rapid heartbeat and friction rub were audible, and a 6-cm linear scar was observed on the right upper chest. Edema of both lower extremities was observed. At the age of 6 in 1950, he was wounded in the chest during a shooting spree by North Korean soldiers during the Korean War. However, at that time he could not visit a hospital and was treated with folk remedies. On the chest X-ray, a bullet adjacent to the right cardiac border and bilateral pleural effusion was noted (Fig. 1). On electrocardiography, he had typical atrial flutter with 2-to-1 atrioventricular conduction, and his heart rate was 150 bpm (Fig. 2). An axial computed tomographic image (Fig. 3A) showed that the bullet was likely located in the right atrium. Thickening of the pericardium was also observed. A long axis reformatted image (Fig. 3B) and a three-dimensional volume-rendered image (Fig. 3C) confirmed that the bullet was located in the epicardial fat and abutted the right atrium at an acute angle. Transthoracic echocardiography during the atrial flutter and sinus rhythm revealed bi-atrial enlargement, thickened pericardium, septal bouncing motion, and significant respiratory variations of the mitral inflow velocity, which were compatible with constrictive pericarditis (Fig. 4). The E/A and E/e' ratios were 4.4 and 8, respectively. The septal e' was higher than the lateral e' (12 cm/sec and 10 cm/sec, respectively). To rule out lead poisoning from the bullet, the patient's blood lead level was checked and lead was undetectable. Atrial flutter and constrictive pericarditis were the suspected causes of the palpitation and dyspnea on exertion. An electrophysiological study confirmed that the atrial flutter was cavotricuspid isthmus-dependent: during the electrophysiological study, fluoroscopy showed that the bullet moved primarily with respiratory movements and partially with heart-beating movements. Moreover, pericardial calcification was also observed adjacent to the coronary sinus. Radiofrequency catheter ablation for ty-pical atrial flutters was performed by a bidirectional conduction block of the cavotricuspid isthmus. One week after radiofrequency catheter ablation, surgical extraction of the bullet and pericardiectomy were performed. In the surgical field, the pericardium was th-ickened and the bullet was severely adhered to the adjacent epicardial tissue (Fig. 5). There were scattered substances around the bullet, which were presumed to be gunpowder. Due to the gunpowder, the pericardium was thickened and stiffened. The rusted bullet was extracted 63 years after the initial gunshot wound. The pathology of the adjacent epicardial tissue showed dystrophic calcification (Fig. 6). After surgery, the patient recovered without complications and there was no echocardiographic evidence of constrictive physiology.


Constrictive Pericarditis Long after a Gunshot Wound.

Choi JH, Uhm JS, Lee SE, Chun KH, Lee HJ, Lee SH, Hong GR, Lee MH - Korean Circ J (2015)

Pulsed-wave Doppler image reveals significant respiratory variation of the mitral inflow velocity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4521112&req=5

Figure 4: Pulsed-wave Doppler image reveals significant respiratory variation of the mitral inflow velocity.
Mentions: A 69-year-old man visited our hospital for palpitation and dyspnea on exertion. The symptoms began four months prior to his visit to the hospital. On physical examination, a rapid heartbeat and friction rub were audible, and a 6-cm linear scar was observed on the right upper chest. Edema of both lower extremities was observed. At the age of 6 in 1950, he was wounded in the chest during a shooting spree by North Korean soldiers during the Korean War. However, at that time he could not visit a hospital and was treated with folk remedies. On the chest X-ray, a bullet adjacent to the right cardiac border and bilateral pleural effusion was noted (Fig. 1). On electrocardiography, he had typical atrial flutter with 2-to-1 atrioventricular conduction, and his heart rate was 150 bpm (Fig. 2). An axial computed tomographic image (Fig. 3A) showed that the bullet was likely located in the right atrium. Thickening of the pericardium was also observed. A long axis reformatted image (Fig. 3B) and a three-dimensional volume-rendered image (Fig. 3C) confirmed that the bullet was located in the epicardial fat and abutted the right atrium at an acute angle. Transthoracic echocardiography during the atrial flutter and sinus rhythm revealed bi-atrial enlargement, thickened pericardium, septal bouncing motion, and significant respiratory variations of the mitral inflow velocity, which were compatible with constrictive pericarditis (Fig. 4). The E/A and E/e' ratios were 4.4 and 8, respectively. The septal e' was higher than the lateral e' (12 cm/sec and 10 cm/sec, respectively). To rule out lead poisoning from the bullet, the patient's blood lead level was checked and lead was undetectable. Atrial flutter and constrictive pericarditis were the suspected causes of the palpitation and dyspnea on exertion. An electrophysiological study confirmed that the atrial flutter was cavotricuspid isthmus-dependent: during the electrophysiological study, fluoroscopy showed that the bullet moved primarily with respiratory movements and partially with heart-beating movements. Moreover, pericardial calcification was also observed adjacent to the coronary sinus. Radiofrequency catheter ablation for ty-pical atrial flutters was performed by a bidirectional conduction block of the cavotricuspid isthmus. One week after radiofrequency catheter ablation, surgical extraction of the bullet and pericardiectomy were performed. In the surgical field, the pericardium was th-ickened and the bullet was severely adhered to the adjacent epicardial tissue (Fig. 5). There were scattered substances around the bullet, which were presumed to be gunpowder. Due to the gunpowder, the pericardium was thickened and stiffened. The rusted bullet was extracted 63 years after the initial gunshot wound. The pathology of the adjacent epicardial tissue showed dystrophic calcification (Fig. 6). After surgery, the patient recovered without complications and there was no echocardiographic evidence of constrictive physiology.

Bottom Line: Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium.Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period.The history of the patient revealed an injury by gunshot during the Korean War in 1950.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications.

No MeSH data available.


Related in: MedlinePlus