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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Fontan operation and its modifications can be relatively safely performed in the treatment of many complex congenital heart diseases, such as univentricular heart and tricuspid atresia. The main postoperative complications following the Fontan procedure and the incremental risk factors involved in their development are investigated. Between January 1984 and January 1988 eleven patients (6 females and 5 males), ranging in age from 2 to 15 years (mean age: 7.3 +/- 3.7) and in weight from 10.8 to 50 Kg (mean weight 22.3 +/- 12.7) underwent the Fontan operation in our Department. No hospital death occurred. The mean postoperative stay in the Intensive Care Unit was 6.3 +/- 3.9 days. There were two surgical re-entries for the same patient: cardiac tamponade (the day of operation) and residual atrial septal defect (2 days following the operation). Eight patients had significant signs of venous stasis, with severe hepatomegaly and pleural effusion. The 11 patients discharged were followed-up for a period of between 3 and 48 months (mean follow-up: 26.4 +/- 18). There were 2 cases of recurrent pleural effusion, 10 to 15 days after discharge. One late death occurred 2 years after the Fontan procedure (massive pulmonary embolism after re-operation). Short and medium-term rate of complications is related to increased post-operative values of mean right atrial pressure (greater than 15 mmHg). Mean right atrial pressures greater than 15 mmHg appear to be correlated with Nakata index values less than 250 mm2/m2. The experience reviewed confirms the excellent results of the Fontan operation, as regards survival and functional recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fontan's operation: results, immediate and long-term postoperative complications]. 227 18

The patient presented in this paper had been stable for 3 months after the induction of hemodialysis, when nausea, vomiting and hepatomegaly suddenly developed. A chest film revealed rush cardiomegaly, and massive pericardial effusion was demonstrated by echocardiography. One liter of hemorrhagic fluid was removed by pericardiocentesis and subsequent pericardial drainage under echocardiography. The patient received chemotherapy against pulmonary tuberculosis 30 years ago and calcification on chest film was apparent. Although sputum smear and pericardial effusion was negative for acid-fast organisms, combination therapy was initiated for suspected tuberculosis. The patient recovered completely and 2 months later it was demonstrated that cultures of sputum grew mycobacterium tuberculosis. Tuberculin skin test (PPD), which was negative 2 months previously, converted to positive. Tuberculosis must be considered as a potential cause of pericardial tamponade in patients on regular hemodialysis, and prompt therapy for both cardiac tamponade and the occult infection is warranted.
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PMID:Tuberculosis on regular hemodialysis--a case of pericardial tamponade. 276 29

We experienced two cases of liver metastasis resulting from thymoma, which is reported to be rare in Japan. Case 1 was a 57-year-old man who was admitted because of hepatomegaly. US, CT and angiography revealed multiple tumors in the liver which were thought to be liver metastasis from an unknown origin. He died of cardiac tamponade one year later. An autopsy revealed thymoma with metastasis to the liver, lung and pericardium. Case 2 was a 32-year-old female who visited our hospital complaining of right hypochondriac pain, US detected several large hyperechoic masses in the liver. A us-guided liver biopsy confirmed metastasis from thymoma. Histological tests of the liver of these two cases showed epithelial type of thymoma.
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PMID:[Liver metastasis of thymoma--report of two cases]. 359 78

The authors describe a case of lymphoblastic lymphoma of the renal lodge complicated by hemorrhagic pericarditis, cardiac tamponade and quickly evolved in an unfavourable way. Lymphoblastic lymphoma is classified into lymphocytic lymphomas (or non-Hodgkin) with a higher grade of malignancy. These lymphomas have, in 40% of cases, an initially extra-lymph node localization: among these, the renal or perirenal localization is not very frequent. The concomitant presence of a pericarditis of hemorrhagic type is also less frequent. Unlike Hodgkin's lymphomas, lymphocytic lymphomas are frequently in an advanced stage at the moment of diagnosis, and their evolution is of acute-subacute, often fatal type. The case report is about a 70 year old male, who arrived at the clinical investigation for the subjective presence of asthenia, dyspnea, tachycardia and the objective evidence of jugular turgor, hepatomegaly and distal edemas, hypophonesis of right lung basis, according to a clinical picture of systemic venous congestion which instrumental examinations confirm to be of pericardial origin. The abdominal echographic examination showed an occupation of the perirenal space, so the CAT characterized as a 25 cm long formation (from the renal cavity to pelvis), with a dislocation of close structures. Unfortunately, the clinical picture had a quick evolution towards the exitus for cardiac tamponade, only permitting us a bioptic examination for the diagnosis of the case.
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PMID:[Lymphoblastic lymphoma of the renal cavity associated with hemorrhagic pericarditis. Description of a case]. 785 60

A case of glycogen storage disease associated with multiple hepatic adenomas and Niemann-Pick disease is reported. Type IA glycogen disease was diagnosed soon after birth in a female patient, and she was treated at our clinic. At the age of 12 yr, the patient was found to have a hepatic tumor, which was surgically extirpated. Histological examination showed that the tumor was a hepatocellular adenoma. Increasing hepatomegaly and jaundice were noted when the patient was 18 yr of age. She died of pneumonia and cardiac tamponade at the age of 19. The liver weighed 3310 g, and showed severe jaundice and many nodules measuring up to 8 cm in diameter. These nodules were composed of mature hepatocytes without atypia and were diagnosed as hepatocellular adenomas. In addition, many adenomatous lesions were found at the microscopical level. The spleen weighed 1310 g, and showed two small infarctions at the upper part. A histological examination showed a diffuse infiltration of large foamy cells in the splenic red pulp. These cells were 20 to 100 microns in diameter and weakly positive for periodic acid-Schiff (PAS) staining, positive for lipid staining with Sudan black B, and positive for Pearce's phospholipid staining. Electron microscopy showed many lamellar bodies in the cytoplasm that were characteristic of Niemann-Pick disease. These foamy cells were also found in liver, bone marrow, lymph nodes, kidneys, and lungs.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Glycogen storage disease associated with Niemann-Pick disease: histochemical, enzymatic, and lipid analyses. 805 18

A seven-year-old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. Pericardiocentesis was negative in the emergency room. Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the 'Golden Hour' saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.
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PMID:Survival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery. 967 35

This report describes a case of cardiac tamponade as the initial manifestation of unclassified connective tissue disease (UCTD). A 68-year-old Japanese woman was admitted to hospital because of dyspnea and edema. She had undergone a radical left mastectomy for the treatment of breast cancer 18 years before. On admission, bilateral leg edema, hepatomegaly, and a paradoxical pulse were noted on physical examination. The erythrocyte sedimentation rate was elevated and the C-reactive protein was 2.8 mg/dl. Antinuclear antibodies and anti-SS-A/Ro antibodies were present. The scl-70 and anticentromere antibodies were elevated. Chest radiography showed cardiomegaly. Echocardiography revealed a large pericardial effusion, but the pericardial fluid did not contain malignant cells or bacteria. She did not meet the diagnostic criteria for any known connective tissue diseases, so was diagnosed with cardiac tamponade due to UCTD. Prednisolone (30 mg/day) was administered, which resulted in a gradual resolution of the pericardial effusion. Although connective tissue diseases are known to cause pericardial effusion, cardiac tamponade as the initial manifestation of the disease in the absence of other symptoms is quite rare.
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PMID:Unclassified connective tissue disease presenting as cardiac tamponade: a case report. 1095 61

Pleuropulmonary amebiasis is the common and pericardial amebiasis the rare form of thoracic amebiasis. Low socioeconomic conditions, malnutrition, chronic alcoholism, and ASD with left to right shunt are contributing factors to the development of pulmonary amebiasis. Although no age is exempt, it commonly occurs in patients aged 20 to 40 years, with an adult male to female ratio of 10:1. Children rarely develop thoracic amebiasis: when it does occur there is an equal sex distribution. The infection usually spreads to the lungs by extension of an amebic liver abscess. Infection may pass to the thorax directly from the primary intestinal lesion through hematogenous spread, however. Lymphatic spread is one possible route. Inhalation of dust containing cysts and aspiration of cysts or trophozoites of E histolytica in the lungs are some other hypothetical routes. The lung is the second most common extraintestinal site of amebic involvement after the liver. Usually the lower lobe, and sometimes the middle lobe of the right lung, are affected, but it may affect any lobe of the lungs. The patient develops fever and right upper quadrant pain that is referred to the tip of the right shoulder or in between the scapula. Hemophtysis is common. The diagnosis of thoracic amebiasis is suggested by the combination of an elevated hemidiaphragm (usually right), hepatomegaly, pleural effusion, and involvement of the right lung base in the form of haziness and obliteration of costophrenic and costodiaphragmatic angles. Infection is usually extended to the thorax by perforation of a hepatic abscess through the diaphragm and across an obliterated pleural space, producing pulmonary consolidation, abscesses, or broncho-hepatic fistula. Empyema develops when a liver abscess ruptures into the pleural space. Rarely, a posterior amebic liver abscess can burst into the inferior vena cava and develop an embolism of the inferior vena cava and thromboembolic disease of the lungs with congestive cardiac failure or corpulmonale. Diagnosis by finding E histolytica in stool specimens is of limited value. In a limited number of cases amebae might be found in aspirated pus or expectorated sputum. "Anchovy sauce-like" pus or sputum may be found. Presence of bile in sputum indicates that the pus is of liver origin. Serological tests are of immense value in diagnosis. Liver enzymes are usually normal and neutrophilic leucocytosis may or may not be found. ESR is invariably elevated. Anti-amebic antibodies can be detected by ELISA, IFAT, and IHA. Amebic antigen can be detected from serum and pus by ELISA. Detection of Entamoeba DNA in pus or sputum may be a sensitive and specific method. Pleuropulmonary amebiasis is easily confused with other illnesses and is treated as pulmonary TB, bacterial lung abscesses, and carcinoma of the lung. A single drug regimen with metronidazole with supportive therapy usually cures patients without residual anomalies. Aspiration of pus from empyema thoracis may be needed for confirmation and therapeutic purposes. The pericardium is usually involved by direct extension from the amebic abscess of the left lobe of the liver, sometimes from the right lobe of the liver, and rarely from the lungs or pleura. An initial accumulation of serous fluid due to reactive pericarditis followed by intrapericardial rupture may develop either (1) acute onset of severe symptoms with chest pain, dyspnea, and cardiac tamponade, shock, and death, or (2) progressive effusion with thoracic cage pain, progressive dyspnea, and fever. Chest radiograph, ultrasound examination, and CT scan usually confirm the presence of a liver abscess in continuity with the pericardium and fluid within the pericardial sac with or without the fistulous tract. Echocardiography may demonstrate fluid in the pericardial cavity. Patients should be cared for in the ICU and ambecides should be started without delay. Pericardiocentesis usually confirms the diagnosis and improves the general condition of the patient. Aspiration of the accumulated fluid should be performed urgently in cardiac tamponade; repeated aspiration may be needed. Surgical drainage should be done if needed. Acanthamoeba, a free-living ameba, may also infect the lungs in the form of pulmonary nodular infiltration and pulmonary edema in association with amebic meningoencephalitis in immunocompromised patients. It usually spreads to the meninges of the brain by way of the blood from its primary lesion in the lung or skin. Early diagnosis and institution of treatment may be life saving for these patients. A literature review shows that HIV/AIDS patients are not prone to infection with E histolytica. It is now clear that there are an increasing number of HIV-seropositive patients among amebic liver abscess patients, however, which suggests that although the incidence of intestinal infection is not high among HIV-seropositive or AIDS patients they are more susceptible to an invasive form of the disease.
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PMID:Thoracic amebiasis. 1209 41

We present a case of 39-year-old male with symptomatic cardiac tamponade due to neoplastic disease. Because of abdominal symptoms the patient was diagnosed as having acute abdomen and underwent exploratory laparatomy which revealed enlarged liver and ascites. Correct diagnosis was established later by echocardiography and effective pericardiocentesis was performed. Diagnostic difficulties in patients with cardiac tamponade are discussed.
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PMID:[Cardiac tamponade as a cause for exploratory laparatomy - a case report]. 1450 1

Pericardial abscess is rare in healthy individuals, especially the amebic type. We report a case of pericardial abscess and cardiac tamponade due to intrapericardial rupture of an amebic liver abscess. A 31-year old Japanese male complained of fever to a local hospital. A liver mass was discovered in his left hepatic lobe by an abdominal echogram. He was referred to the internal department of our hospital and was treated with quinolone antibiotics. Two weeks after medication, he suddenly complained of epigastralgia and severe orthopnea and was admitted. Abdominal computed tomographic scan showed an enlarged liver mass, and massive pericardial effusion suggested cardiac tamponade. He underwent an emergency subxiphoid partial pericardiectomy under local anesthesia. 1,000 ml of light brownish fluid was removed and his condition improved. Although no ameba was cultivated from the pus, the amebic serological test was positive. Metronidazole was administered and the patient was discharged 31 days after surgery.
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PMID:Cardiac tamponade due to intrapericardial rupture of an amebic liver abscess. 1587 56


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