Case 3 presentation John P. Veinot MD, FRCPC Professor of Pathology & Cardiology University of Ottawa Ottawa Hospital, Ottawa Heart Institute UNIVERSITY OF OTTAWA HEART INSTITUTE UNIVERSITY OF OTTAWA HEART INSTITUTE UNIVERSITY OF OTTAWA HEART INSTITUTE UNIVERSITY OF OTTAWA HEART INSTITUTE Clinical • 51 year old married male • 2 pack/ day smoker • recent diagnosis of hypertension • flu like illness - fever, pleuritic chest pain Clinical • admitted to peripheral hospital, treated for pericarditis with NSAID • presented to ER with chest pain , dyspnea, fever and elevated JVP • query tamponade, and transferred to Heart Institute Clinical • Physical exam: HR 120, BP 120/60 with pulsus paradoxicus, • JVP elevated with Kussmauls sign, • basal crackles; no friction rub • Lab: WBC 16, Hb 103, ALP 226, CK 31 • ECG: diffuse T wave abnormalities with mild depression of the PR segment • ECHO Clinical • Echo significant pericardial effusion and impending tamponade • Provisional diagnosis: viral pericarditis with tamponade Clinical • Pericardiocentesis: 620 ml serosanguinous fluid, culture and cytology negative, started on Entrophen 650 mg bid • CT chest: multiple small nodules possibly metastatic disease • Respirology consult: recommended R/O TB • prednisone 40 mg daily for 10 days • left thoracentesis 630 ml turbid yellow fluid, culture and cytology specimen clotted so not sent, pleural biopsy reactive mesothelial cells
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Case 3 presentation
John P. Veinot MD, FRCPC
Professor of Pathology & Cardiology
University of Ottawa
Ottawa Hospital, Ottawa Heart Institute
UNIVERSITY OF OTTAWA HEART INSTITUTEUNIVERSITY OF OTTAWA HEART INSTITUTEUNIVERSITY OF OTTAWA HEART INSTITUTEUNIVERSITY OF OTTAWA HEART INSTITUTE
Clinical
• 51 year old married male
• 2 pack/ day smoker
• recent diagnosis of hypertension
• flu like illness - fever, pleuriticchest pain
Clinical
• admitted to peripheral hospital,
treated for pericarditis with NSAID
• presented to ER with chest pain ,
dyspnea, fever and elevated JVP
• query tamponade, and transferred to Heart Institute
Clinical
• Physical exam: HR 120, BP 120/60 with pulsus paradoxicus,
• JVP elevated with Kussmauls sign, • basal crackles; no friction rub
• Lab: WBC 16, Hb 103, ALP 226, CK 31
• ECG: diffuse T wave abnormalities with mild depression of the PR segment
• ECHO
Clinical
• Echo
significant pericardial effusion and impending tamponade
• Provisional diagnosis: viralpericarditis with tamponade
Clinical
• Pericardiocentesis: 620 ml serosanguinousfluid, culture and cytology negative, started on Entrophen 650 mg bid
• CT chest: multiple small nodules possiblymetastatic disease
• Respirology consult: recommended R/O TB
• prednisone 40 mg daily for 10 days
• left thoracentesis 630 ml turbid yellow fluid, culture and cytology specimen clotted so not sent, pleural biopsy reactivemesothelial cells