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1.
Rev. urug. cardiol ; 36(1): e36108, abr. 2021. ilus
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1252493

ABSTRACT

Los linfomas cardíacos primarios son un subtipo muy poco frecuente de tumor en los cuales la lesión primaria se encuentra en el corazón. Los tumores suelen ser infiltrantes y se localizan en la aurícula derecha, seguidos del pericardio. Su mortalidad es notablemente alta y el diagnóstico tardío es el principal factor para su mal pronóstico. Describimos el caso de un paciente que presentó shock obstructivo por derrame pericárdico profuso causado por un tipo raro de tumor cardíaco primario, un linfoma pericárdico de células T/NK.


Primary cardiac lymphomas are a rare subtype of lymphomas in which the primary lesion is in the heart. The tumors are usually located in the right atria, followed by the pericardium and are frequently infiltrative. Mortality is remarkably high in this group and the delayed diagnosis is the main factor for its poor prognosis. We describe the case of a patient that presented with obstructive shock due to profuse pericardial effuse caused by a rare kind of primary cardiac tumor, a T/NK cell pericardial lymphoma.


Os linfomas cardíacos primários são um subtipo de tumor muito raro, no qual a lesão primária está no coração. Os tumores geralmente são infiltrativos e localizam-se no átrio direito, seguidos pelo pericárdio. Sua mortalidade é notavelmente alta e o diagnóstico tardio é o principal fator que produz seu mau prognóstico. Descrevemos o caso de um paciente que apresentou choque obstrutivo devido a um derrame pericárdico profuso causado por um tipo raro de tumor cardíaco primário, um linfoma pericárdico de células T/NK.


Subject(s)
Humans , Female , Aged , Lymphoma, T-Cell/pathology , Lymphoma, T-Cell/drug therapy , Lymphoma, T-Cell/diagnostic imaging , Heart Neoplasms/pathology , Heart Neoplasms/drug therapy , Heart Neoplasms/diagnostic imaging , Pericardial Effusion/therapy , Pericardial Effusion/diagnostic imaging , Pericardium/pathology , Cardiac Tamponade/therapy
2.
Iatreia ; 34(1): 78-83, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1154361

ABSTRACT

RESUMEN El coma mixedematoso es la complicación más grave de un hipotiroidismo. Ocurre, por lo general, en mujeres ancianas con hipotiroidismo conocido sin un adecuado manejo y en presencia de un evento desencadenante. El diagnóstico es difícil y debe realizarse en forma oportuna para disminuir el riesgo de muerte. El coma es una de las presentaciones neurológicas de esta urgencia endocrinológica y no es necesario su presencia para el diagnóstico. En este reporte de caso se presentan varías manifestaciones inusuales en un paciente masculino con hipotiroidismo profundo que, al diagnóstico, debutó con coma mixedematoso con predictores de mal pronóstico durante la hospitalización, pero debido al abordaje temprano y el manejo integral, se dio una resolución satisfactoria a esta urgencia endocrinológica infrecuente.


SUMMARY Myxedema coma is the most serious complication of hypothyroidism. It usually occurs in the context of elderly women, with known hypothyroidism without proper management and in the presence of a triggering event. The diagnosis is challenging and must be made in a timely manner to prevent the development of adverse outcomes. Coma is one of the neurological manifestations of the entity, not being necessary for its diagnosis. This case report presents a constellation of unusual manifestations of a male patient with myxedema coma at the debut of severe hypothyroidism with predictors of poor prognosis during hospitalization, but due to the early approach and comprehensive management, this uncommon endocrinological emergency was satisfactorily resolved.


Subject(s)
Humans , Aged , Pericardial Effusion , Myxedema , Seizures , Coma
3.
Repert. med. cir ; 30(2): 163-169, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362729

ABSTRACT

Objetivo: el taponamiento cardiaco por causas clínicas es una entidad rara y de difícil diagnóstico. Metodología: se reporta el caso de una paciente atendida en el nivel de mediana complejidad por taponamiento cardiaco de origen oncológico de novo. Se analiza la fisiopatología del derrame, causas etiológicas del taponamiento cardiaco, presentación clínica, valor de las ayudas diagnósticas a la mano en estos casos y las utilizadas en situaciones especiales, así como el manejo de esta patología


Objective: Cardiac tamponade for clinical causes is a rare and difficult to diagnose entity. Methodology: we report the case of a female patient treated at a mid-level hospital for cardiac tamponade due to de novo metastatic disease. The physiopathology of the effusion, etiological causes, clinical manifestations, value of diagnostic aids available for these cases and those used in special situations, as well as the management of this pathology, were analyzed


Subject(s)
Humans , Female , Middle Aged , Pericardium , Cardiac Tamponade , Pericardial Effusion , Pericardiocentesis
4.
ABC., imagem cardiovasc ; 34(2)2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1283777

ABSTRACT

A amiloidose é uma condição rara que descreve um grupo heterogêneo de distúrbios que cursam com a deposição extracelular de agregados proteicos fibrilares em tecidos e órgãos. Relata-se aqui o caso de paciente do sexo masculino, com 76 anos de idade, que, há 2 meses, iniciou quadro progressivo de dispneia aos mínimos esforços. Na investigação, observou-se aumento cardíaco global, e o ecocardiograma evidenciou cardiopatia restritiva infiltrativa e derrame pericárdico. Pela elevada suspeição clínica, foi solicitada ressonância magnética cardíaca, que foi altamente sugestiva de amiloidose cardíaca. Dessa forma, assim como no caso relatado, o acometimento cardíaco possui como principal forma de manifestação o tipo miocardiopatia restritivo, sendo um quadro de insuficiência cardíaca crônica com etiologia de difícil diagnóstico em pacientes acima de 50 anos, com prognóstico bastante reservado. Assim, apesar de permanecer como um desafio diagnóstico para o clínico, sua hipótese deve sempre ser aventada na ausência de outra causa que justifique tais achados (AU)


Subject(s)
Humans , Male , Aged , Cardiomyopathy, Restrictive/physiopathology , Cardiomyopathy, Restrictive/diagnostic imaging , Atrioventricular Block/pathology , Pericardial Effusion/diagnostic imaging , Time Factors , Magnetic Resonance Imaging , Echocardiography , Magnetic Resonance Spectroscopy , Comorbidity , Hypertrophy, Left Ventricular/diagnostic imaging , Electrocardiography , Lymphadenopathy/diagnostic imaging , Amyloidosis
5.
Article in Chinese | WPRIM | ID: wpr-879843

ABSTRACT

OBJECTIVE@#To study the clinical features of pericardial effusion caused by central venous catheterization in preterm infants.@*METHODS@#A retrospective analysis was performed on 11 preterm infants with pericardial effusion caused by central venous catheterization. Their catheterization features, manifestations, treatment, and prognosis were analyzed.@*RESULTS@#A total of 11 preterm infants (11/2 599, 0.42%) developed pericardial effusion, with a mean gestational age of (30.1±2.6) weeks and a mean birth weight of (1 240±234) g. Pericardial effusion mostly occurred within 4 days after central venous catheterization (10 cases, 91%). The main manifestations included poor response (6/11, 55%), cyanosis (5/11, 45%), increased respiratory rate (6/11, 55%), increased heart rate (6/11, 55%), aggravated dyspnea (5/11, 45%), and muffled heart sound (5/11, 45%). At the time of disease progression, 7 preterm infants (64%) had a deep position of the end of the catheter, 3 preterm infants (27%) had a correct position, and 1 preterm infant (9%) had a shallow position. Five preterm infants (45%) experienced cardiac tamponade, among whom 4 underwent pericardiocentesis. Seven preterm infants were given conservative medical treatment. Among the 11 children, 2 (18%) died and 9 (82%) improved.@*CONCLUSIONS@#Pericardial effusion caused by central venous catheterization mostly occurs in the early stage of catheterization and has critical clinical manifestations. Pericardiocentesis is required for cardiac tamponade, and early diagnosis and intervention can effectively improve prognosis.


Subject(s)
Catheterization, Central Venous/adverse effects , Child , Humans , Infant , Infant, Newborn , Infant, Premature , Pericardial Effusion/therapy , Pericardiocentesis , Retrospective Studies
7.
CorSalud ; 12(4): 402-407, tab, graf
Article in Spanish | LILACS | ID: biblio-1278954

ABSTRACT

RESUMEN Introducción: El derrame pericárdico en la paciente embarazada es infrecuente, pero se ha visto su presencia en algunos casos aislados sin repercusión hemodinámica, por lo que no se describe la evolución y la conducta a seguir en estas pacientes. Objetivos: Caracterizar a la paciente embarazada con derrame pericárdico, según variables clínicas, epidemiológicas y de laboratorio; y determinar el tiempo de evolución del derrame pericárdico posterior al parto. Método: Se realizó un estudio observacional descriptivo prospectivo con 15 embarazadas con diagnóstico de derrame pericárdico, definido por ecocardiograma transtorácico, seleccionadas de forma intencional de una población de 256 mujeres en estado de gravidez, que fueron atendidas en el Hospital Universitario Gineco-Obstétrico Mariana Grajales de la ciudad de Santa Clara (Villa Clara, Cuba) durante el período de julio 2018 a marzo 2019. Resultados: De las 256 pacientes, solo 15 (5,9%) presentaron derrame pericárdico. El 80% de estos derrames fue encontrado en pacientes con preeclampsia. El 66,7% tenía entre 20 y 29 años de edad, y el 73,3%, color blanco de piel. El derrame fue predominantemente leve (66,7%) y nunca grave, y las pacientes afectadas tenían, además, hipertensión arterial crónica (40%), obesidad (20%) y enfermedad del colágeno (13,3%). En el 86,7% de los casos el derrame pericárdico desapareció en los primeros 15 días posparto. Conclusiones: El derrame pericárdico fue encontrado con más frecuencia en pacientes con preeclampsia, hipertensión arterial crónica, obesidad, proteinuria, hipoproteinemia e hipoalbuminemia; y desapareció, en la mayoría de los casos, en los primeros 15 días posparto.


ABSTRACT Introduction: Pericardial effusions are infrequent in pregnant patients, but its presence has been seen in some isolated cases without hemodynamic involvement. Therefore, neither outcome nor treatment of these cases are described. Objectives: To characterize pregnant patients with pericardial effusion, according to clinical, epidemiological and laboratory variables and determine the recovery time from post-delivery pericardial effusion. Method: A prospective descriptive observational study was carried out with 15 pregnant women with pericardial effusion, diagnosed by transthoracic echocardiogram, intentionally selected from a population of 256 pregnant women who were treated at the Hospital Universitario Gineco-Obstétrico Mariana Grajales in the city of Santa Clara (Villa Clara, Cuba) during the period from July 2018 to March 2019. Results: Of the 256 patients, only 15 (5.9%) presented pericardial effusion. Eighty percent of these effusions were found in patients with pre-eclampsia. A total of 66.7% were aged between 20 and 29 years and 73.3% were white. Effusions were predominantly mild (66.7%) and never severe, and the affected patients also had chronic high blood pressure (40%), obesity (20%) and collagen disease (13.3%). In 86.7% of cases the pericardial effusion resolved in the first 15 days postpartum. Conclusions: Pericardial effusion was more frequently found in patients with pre-eclampsia, chronic arterial hypertension, proteinuria, hypoproteinemia and hipoalbuminemia, and in most cases resolved within the first 15 days postpartum.


Subject(s)
Pericardial Effusion , Pregnancy
8.
Rev. méd. Maule ; 36(2): 50-56, dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1344677

ABSTRACT

BACKGROUND: Cardiac tamponade is a medical emergency that occurs when fluid accumulates in the pericardial space, its prompt diagnosis and treatment can prevent a fatal outcome. OBJECTIVES: We describe a case of cardiac tamponade in a medicine Ward and its subsequent resolution. CLINICAL CASE: 56-year-old male patient with dyspnoea and edematous síndrome, managed with partial response depletive therapy. Echocardiographic study reveals a large pericardial effusion with signs of cardiac tamponade. Inmediate management with ultrasound-guided pericardiocentesis and subsequent surgical resolution. DISCUSSION: The knowledge of the clinical-hemdynamic manifestations and their subsequent pathophysiological background are important in the diagnostic suspicion and management considerations. Echocardiography is a critical component for the final diagnosis, since given its sensitivity and specificity it allows to complete the characterization of the pericardial effusion. In addition, it contributes to reducing the morbidity associated with its drainage.


Subject(s)
Humans , Male , Middle Aged , Pericardial Effusion/diagnosis , Pericardial Effusion/therapy , Cardiac Tamponade/diagnosis , Cardiac Tamponade/therapy , Echocardiography , Cardiology , Hemodynamics
9.
Rev. bras. cir. cardiovasc ; 35(6): 1017-1019, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1144003

ABSTRACT

Abstract Case Presentation: A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.


Subject(s)
Humans , Male , Middle Aged , Pericardial Effusion/surgery , Pericardial Effusion/etiology , Pericardial Effusion/diagnostic imaging , Cardiac Tamponade/surgery , Cardiac Tamponade/etiology , Cardiac Tamponade/diagnostic imaging , Wounds, Penetrating , Wounds, Stab/surgery , Wounds, Stab/complications , Sternotomy
10.
Rev. argent. cir ; 112(2): 193-196, 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1125802

ABSTRACT

Presentamos el caso de una paciente septuagenaria, con vómitos, neumonía por broncoaspiración y síndrome de impregnación neoplásica. Los estudios por imágenes muestran la totalidad del estómago herniado en el pericardio a través de una ventana pericardio-peritoneal realizada previamente. Se realizó la resolución quirúrgica del caso. Se hacen consideraciones sobre las opciones para el tratamiento del derrame pericárdico persistente, la hernia gástrica intrapericárdica como complicación, su presentación clínica, hallazgos intraoperatorios, forma de estudio y tratamiento.


We report the case of a 73-year- old female patient with vomiting, aspiration pneumonia and constitutional symptoms. The imaging tests showed total gastric herniation in the pericardial sac through a pericardio-peritoneal window previously created. The case was solved with surgery. The therapeutic options for persistent pericardial effusion are considered. Intrapericardial gastric hernia as a complication, its clinical presentation, intraoperative findings, complementary tests and treatment are discussed.


Subject(s)
Humans , Female , Aged , Pericardium/surgery , Herniorrhaphy , Hernia/complications , Pericardial Effusion , Peritoneal Cavity , Breast Neoplasms/complications , Radiography, Thoracic
11.
Article in English | WPRIM | ID: wpr-786140

ABSTRACT

Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.


Subject(s)
Arteries , Cardiac Tamponade , Conjunctivitis , Diagnosis , Exanthema , Extremities , Fever , Inflammation , Lymphatic Diseases , Mucocutaneous Lymph Node Syndrome , Pericardial Effusion , Pericarditis , Pleural Effusion
13.
Rev. colomb. cardiol ; 26(6): 342-345, nov.-dic. 2019. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1115591

ABSTRACT

Resumen El derrame pericárdico es una acumulación excesiva de líquido en el espacio pericárdico, el cual se ha asociado al empleo crónico de minoxidil desde principios de su uso clínico; este es formulado comúnmente a pacientes con hipertensión arterial de difícil control y con enfermedad renal crónica asociada, por su efecto vasodilatador arterial y poco efecto sobre la circulación venosa. Se expone el caso de un paciente quien presentó clínica sugestiva de derrame pericárdico, el cual fue confirmado por imágenes (rayos X, tomografía y ecocardiografía) y quien además se encontraba en tratamiento de hemodiálisis crónica por enfermedad renal crónica secundaria a síndrome nefrótico. En la literatura existen algunos reportes de casos similares, pero no hay estudios con datos concluyentes que permitan establecer un porcentaje claro de asociación ni la causa de esta enfermedad. Con este reporte de caso se busca aumentar la sospecha diagnóstica de esta asociación para que otros clínicos tengan este posible diagnóstico en mente, una vez se hayan descartado otras etiologías adicionales y puedan suspender a tiempo la medicación a fin de evitar desenlaces catastróficos como el taponamiento pericárdico.


Abstract Pericardial effusion is an excessive accumulation of fluid in the pericardial space and has been associated with the long-term use of minoxidil from the beginning of its clinical use. It is commonly prescribed to patients with difficult to control arterial hypertension and associated chronic kidney disease due to it arterial vasodilator effects and little effect of the venous circulation. A case is presented on a patient who had a clinical picture suggestive of a pericardial effusion, which was confirmed by imaging tests (X-ray, tomography, and cardiac ultrasound). She was also on long-term haemodialysis treatment due to chronic kidney disease secondary to a nephrotic syndrome. There are reports of similar cases in the literature, but there are no studies with conclusive data that may help to establish a clear percentage association or the cause of the disease. This case report seeks to increase the diagnostic suspicion of this association so that other clinicians may have this possible diagnosis in mind, once they have ruled out any other. They can then stop the medication on time in order to prevent catastrophic outcomes like pericardiac tamponade.


Subject(s)
Humans , Male , Adult , Pericardial Effusion , Echocardiography , Cardiac Tamponade , X-Rays , Tomography , Renal Insufficiency, Chronic , Hypertension , Minoxidil
15.
CorSalud ; 11(3): 225-232, jul.-set. 2019. graf
Article in Spanish | LILACS | ID: biblio-1089741

ABSTRACT

RESUMEN Desde la década de 1960 la pericardiotomía subxifoidea se ha convertido en uno de los procedimientos quirúrgicos preferidos para evacuar, de forma rápida y segura, derrames pericárdicos de múltiples etiologías, obtener biopsias, colocar electrodos epicárdicos, e incluso reparar perforaciones cardíacas. Erróneamente existe la creencia de que esta cirugía requiere instrumental quirúrgico específico y personal especialmente entrenado; pero lo cierto es que todo médico que labore en un servicio de emergencia debe conocer la técnica y estar preparado para realizarla rápidamente. Desde que se describió la incisión longitudinal, originalmente con la intención de reparar una herida cardíaca a través del diafragma, varios autores han intentado simplificar la técnica mediante la introducción de innovaciones. En este trabajo se presentan algunas sencillas maniobras que pueden facilitar el abordaje subxifoideo al pericardio y acortar el tiempo de cirugía.


ABSTRACT Since the 1960s, subxyphoid pericardiotomy has become one of the preferred surgical procedures for rapidly and safely evacuating pericardial effusions of different etiologies, obtaining biopsies, placing epicardial electrodes, and even repairing cardiac perforations. This surgery is erroneously thought to require specific surgical instruments and specially trained personnel; but the plain fact is that any doctor working in an emergency department must know the technique and be ready to perform it at any time. Since the longitudinal incision was described, originally attempting to repair a cardiac wound through the diaphragm, some authors have tried to simplify the procedure through innovations. In this article we present some simple maneuvers that may facilitate subxiphoid pericardial access and shorten the surgery time.


Subject(s)
Pericardium , Pericardial Effusion , Pericardiocentesis
16.
Rev. bras. cir. cardiovasc ; 34(4): 484-487, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020488

ABSTRACT

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Subject(s)
Humans , Postoperative Complications/prevention & control , Drainage/instrumentation , Coronary Artery Bypass , Intraoperative Neurophysiological Monitoring/methods , Mediastinum/surgery , Pericardial Effusion/prevention & control , Drainage/methods , Feasibility Studies , Heart Ventricles/injuries
18.
ABC., imagem cardiovasc ; 32(3): 214-216, jul.-set. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1006712

ABSTRACT

Relatamos o caso de um paciente jovem admitido no pronto-socorro com quadro de dor precordial. O eletrocardiograma de admissão identificou supradesnivelamento do segmento ST localizado em parede lateral associado à imagem em "espelho", com enzimas cardíacas altamente elevadas, o que sugere diagnóstico de síndrome coronariana com supradesnivelamento de ST. O ecocardiograma evidenciou derrame pericárdico com fração de ejeção preservada e ausência de alterações segmentares, sugerindo, assim, pericardite aguda, com comprometimento do miocárdio. Desta forma, foi realizada ressonância magnética cardíaca, que evidenciou presença de realce tardio não isquêmico, confirmando o diagnóstico de perimiocardite. Trata-se de situação pouco frequente na prática clínica e que merece maior compreensão e atenção por parte dos médicos que trabalham em prontos-socorros


Subject(s)
Humans , Male , Adolescent , Electrocardiography/methods , Myocarditis , Pericardial Effusion/complications , Pericardial Effusion/diagnosis , Infections/complications , Myocardial Infarction
20.
Rev. cuba. med. mil ; 48(2): e208, abr.-jun. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126619

ABSTRACT

Introducción: El lupus eritematoso sistémico tiene múltiples formas de presentarse; entre las manifestaciones cardíacas, es frecuente la afectación pericárdica, pero es poco frecuente que su forma de debut sea el derrame pericárdico. Objetivo: Destacar la importancia del diagnóstico precoz de una de las formas menos frecuentes de debut del lupus eritamatoso sistémico. Caso clínico: Se presenta el caso de una paciente de 50 años, que ingresó porque desde hacía 3 meses sufría dolor torácico, disnea, tos, síntomas articulares, dermatológicos y generales. Luego de la sospecha y el estudio clínico, hematológico, imagenológico y biopsia de piel, se diagnosticó precozmente derrame pericárdico por lupus eritematoso sistémico. Se impuso tratamiento oportuno con esteroides, y la evolución fue favorable. Conclusiones: A pesar del bajo índice de sospecha, se tuvo en cuenta al lupus eritematoso sistémico y se procedió a las determinaciones analíticas que confirmaron el diagnóstico(AU)


Introduction: Systemic lupus erythematosus has multiple ways of presentation; among cardiac manifestations, pericardial involvement is frequent, but it is rare that its debut form is the pericardial effusion. Objective: To emphasize the importance of early diagnosis of one of the less frequent forms of systemic lupus erythematosus. Clinical case: We present the case of a 50-year-old patient, who had been admitted for 3 months because of chest pain, dyspnea, cough, joint, dermatological and general symptoms. After the suspicion and the clinical, hematological, imaging and skin biopsy, pericardial effusion was diagnosed early due to systemic lupus erythematosus. Timely treatment with steroids was imposed, and the evolution was favorable. Conclusions: Despite the low index of suspicion, the systemic lupus erythematosus was taken into account and the analytical determinations that confirmed the diagnosis were made(AU)


Subject(s)
Humans , Male , Middle Aged , Pericardial Effusion/blood , Skin/microbiology , Cough/drug therapy , Lupus Erythematosus, Systemic/complications , Pericardial Effusion/diagnostic imaging , Biopsy
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