Isolated primary chylopericardium: A rare case report and literature review.

INTRODUCTION: Primary chylopericardium is an extremely rare disease with no previous reported case in Indonesia. It may be caused by an abnormality of lymphatic drainage in the thoracic region. CASE PRESENTATION: We report the case of a 19-year-old female who presented with a chief complaint of shortness of breath and fluid accumulation in her pericardial sac. Screening for autoimmune disease, tuberculosis, and malignancy all came back negative. Lymphoscintigraphy showed suspected leakage or obstruction of lymph at the supradiaphragmatic level. The patient was diagnosed with primary chylopericardium. In a span of 1 year, she had undergone 3 pericardiocentesis procedures and declined surgical treatment. On her fourth pericardiocentesis, the cardiologists were unable to remove fluid from the pericardial sac. Thoracic duct ligation and pericardial window were eventually performed and a total of 850 ml of chylous fluid was removed. At 6 months postoperation patient showed no signs and symptoms of pericardial effusion and was in good condition. DISCUSSION: Constrictive pericarditis can occur as a complication of chronic inflammation in the pericardium due to the presence of chylopericardium and a history of multiple pericardiocenteses. However, there are no reports regarding the exact duration of chylopericardium that will lead to constrictive pericarditis. Difficulty in pericardiocentesis might be an early sign of scarring in the pericardium. CONCLUSION: Delayed surgical treatment of chylopericardium increases the risk of constrictive pericarditis and significantly reduces the patient's quality of life due to recurrent symptoms and hospitalizations.

Conventional Repair of an Intraoperatively Diagnosed Congenitally Corrected Transposition of the Great Arteries in an Adult.

BACKGROUND: Congenitally corrected transposition of the great arteries (ccTGA) is a rare condition that accounts for just 1% of all congenital heart disease. Diagnosis of ccTGA often is missed in adulthood, despite imaging and cardiology consultation. CASE REPORT: We present the case of an intraoperatively diagnosed ccTGA with severe tricuspid valve regurgitation and secundum atrial septal defect in a 54-year-old woman, who preoperatively was diagnosed with mitral valve regurgitation in atrioventricular and ventriculoarterial concordance heart. Intraoperatively, options considered were anatomical repair with atrial-arterial double switch operation after retraining the left ventricle or a conventional repair that focused on the associated defects without addressing the discordant connections. Considering our patient's age and condition, we decided to carry on with the conventional repair to prevent further systemic right ventricle dysfunction that may lead to poor outcome and decreased survival. She was discharged one week after surgery and resumed her normal activity at 3-month follow up. CONCLUSION: Although it rarely happens, CHD such as ccTGA in an adult must always be considered. Careful examination is essential. The treatment of ccTGA in an adult is challenging, with more limited options compared with pediatric patients. However, early management could still provide favorable outcomes.

Osteosarcoma of the rib: A challenge of diagnosis and surgical intervention: A case report.

INTRODUCTION AND IMPORTANCE: Chest wall tumour could grow from various tissues composing the chest wall. Diagnosis and treatment of patients with chest wall tumour pose several challenges. CASE PRESENTATION: We present a case of 55 year old woman with chief complaint of a painfull mass on her chest wall. Patient was diagnosed with osteosarcoma of the ribs. Patient underwent surgery and was hospitalized for seven days before discharged. CLINICAL DISCUSSION: Osteosarcoma of the ribs is a rare case with wide resection as the main treatment. In this case, chest wall reconstruction was needed to prevent impaired chest wall mechanical function in respiration. CONCLUSION: Diagnosis and treatment of osteosarcoma of the ribs pose challenges. The main treatment of the osteosarcoma of the ribs is wide resection, followed by reconstruction of chest wall when needed. Reconstruction could be performed with autologous tissue, gore-tex, and mesh. The adjuvant chemotherapy was considered to give for better outcome.

A Rare Case of Right Ventricular Myxoma with Tricuspid Valve Endocarditis.

BACKGROUND: Although myxoma is the most common form of benign cardiac tumor, which is a rare condition itself, less than 3-4% of cases are detected in the right ventricle (RV). The clinical presentations vary widely and are nonspecific, causing challenging diagnosis. Although rare, myxoma can coexist with infective endocarditis (IE). CASE REPORT: We report a rare case of right ventricular myxoma presenting with dyspnea and fever, which was later found to be complicated with concomitant tricuspid valve endocarditis during surgery as well as the performed surgical approach. CONCLUSION: RV myxoma is a rare entity requiring a high index of suspicion due to varying nonspecific presentations. Concomitant IE should be suspected in patients with persistent fever. Antibiotics and careful surgical approach are needed to prevent complications, including embolization.

A rare case of primary cardiac lymphoma and the role of early surgical debulking: a case report.

BACKGROUND: Primary cardiac lymphoma (PCL) is a very rare disease and is most commonly found among immunocompromised patients. Its cardiac manifestations are non-specific, leading to delayed diagnosis and poor prognosis. However, chemotherapy could improve survival, which makes early and prompt diagnosis very crucial. This is a report of a rare case of PCL found on a 73-year-old man who benefit from early debulking surgery. CASE SUMMARY: A 73-year-old man presented with worsening dyspnoea over the last 2 months. A 7.2 × 10.2 cm intramural tumour was found extending from the right atrium to the right ventricle. It was considered that the tumour could cause sudden death due to its size and extension. Therefore, surgical debulking with biopsy and valve repair was done. Cytology examination from the resected specimen demonstrated diffuse large B-cell lymphoma non-germinal centre B-cell like type. He was discharged 2 weeks after the surgery in stable condition and referred to internal medicine department for chemotherapy. However, he chose palliative home care and died 44 days after surgery. DISCUSSION: In cases of PCL with concerning tumour size and symptoms due to cardiac obstruction, early surgical debulking could improve haemodynamics, prevent sudden death, and confirm immunopathological diagnosis needed in determining further chemotherapy, which is proven to improve survival.