Pericardial effusion and atrial thrombosis: a rare complication of childhood leukemia

Acute lymphoblastic leukemia [ALL] is the most common malignancy diagnosed in children. Extramedullary leukemia including hepatosplenomegaly, lymphadenopathy, and mediastinal mass are the clinical presentations of T-cell ALL. Pericardial effusion and atrial mass are rare presentations of pediatric leukemia. We report a 15-year-old girl with T-cell ALL, who presented initially with pericardial effusion and cardiac tamponade and subsequently developed right atrial mass. The mediastinal and right atrial masses were excised by surgical procedure as a treatment strategy for prevention of arrhythmia and sudden death. T-cell ALL can present with pericardial and mediastinal involvement as an initial manifestation. Pericardiocenthesis and systemic anticancer chemotherapy without local chemotherapy should be considered in these cases

Evaluation of pulsed doppler-versus tissue doppler-derived tei index of right and left ventricle in fetuses

The myocardial performance index [MPI], also known as the Tei index, was introduced by Tei et al. to evaluate cardiac function in adults with dilated cardiomyopathy. This index is defined as the sum of isovolumic contraction time [ICT] and isovolumic relaxation time [IRT], divided by ejection time [ET]. To determine the correlation between pulsed Doppler [PD]- and tissue Doppler imaging [TDI]-derived Tei indices in fetuses. Right and left ventricle PD and TDI echocardiographic data were obtained from 59 fetuses [11 pregnant women who were positive for anti-SSA-Ro or anti-SSB-La antibodies, 18 women who were referred due to dysrhythmia, and 30 women who had normal clinical findings]. Mean fetal gestational age was 27 +/- 6.4 weeks. Mean PD Tei index of the mitral and tricuspid valve was 0.58 +/- 0.05 and 0.53 +/- 0.08, respectively. Mean TDI indices for the mitral and tricuspid valve were 0.56 +/- 0.09 and 0.55 +/- 0.08, respectively. There were no significant differences between mitral and tricuspid PD- and TDI-derived Tei indices [P = 0.87, P= 0.21], but the Bland-Altman diagrams showed no fine agreement between the indices [the mean difference +/- 1 standard deviation of the right ventricular PD- and TDI-derived Tei indices was 0.24 +/- 0.02 and 0.29 +/- 0.04 for the left ventricle]. There were no significant differences in PD- and TDI-derived Tei indexes between groups of evaluated fetuses [Mitral valve: PD-Tei P=0.69, TDI-Tei P=0.49; Tricuspid valve: PD-Tei P=0.41, TDI-Tei P=0.36]. Although the mean values of the two indices did not differ significantly, the TDI-derived and PD-derived Tei indices did not have fine agreement