ABSTRACT
A 53 year old asymptomatic man presented with a primary pericardial mesothelioma masquerading as a benign pericardial effusion. Although M-mode echocardiography showed an echo-free space, two-dimensional echocardiography and thoracic computed tomography demonstrated that the suspected effusion was caused by a mass surrounding the heart. Newer noninvasive techniques can be valuable for the early detection of pericardial tumor.
Subject(s)
Heart Neoplasms/diagnosis , Mesothelioma/diagnosis , Pericardial Effusion/diagnosis , Diagnosis, Differential , Echocardiography , Humans , Male , Middle Aged , Pericardium , Tomography, X-Ray ComputedABSTRACT
Diastolic pressure-volume (P-V) curves were calculated on a beat-to-beat basis in the open-chest, pentobarbital-anesthetized dog, using the technique of direct transmitral flow measurement previously described. P-V curves were constructed and the slope (dP/dV) was plotted vs. pressure and time. dP/dV was used as an index of stiffness in each heart and its instantaneous changes with time were followed throughout the diastolic period. The end-diastolic P-V relation based on points from successive cycles during volume loading was found to be exponential. In contrast, the instantaneous P-V relation during any one diastolic period was not exponential. That is, the dynamic dP/dV vs. pressure plot was nonlinear. In the normal heart, stiffness was characterized in early diastole by a negative dP/dV as the ventricle continued to relax, and then frequently decreased prior to a second stiffness rise with atrial augmentation. These findings can be explained by a model containing an element whose deformation is rate dependent, i.e., a parallel viscous element. Stiffness profiles in mitral stenosis where dynamic effects are minimized substantiate this conclusion.
