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Case Reports
. 2022 Jul 6;4(13):808-813.
doi: 10.1016/j.jaccas.2022.04.001.

Cholesterol Pericarditis

Tasveer Khawaja  1 , Rafey Feroze  2 , Brian D Hoit  1   2
Affiliations
Case Reports

Cholesterol Pericarditis

Tasveer Khawaja et al. JACC Case Rep. .

Abstract

Cholesterol pericarditis is a rare condition characterized by a large, chronic cholesterol-rich pericardial effusion that often manifests with symptoms of heart failure. We report a case of an asymptomatic 51-year-old man with a massive cholesterol-rich pericardial effusion with echocardiographic evidence of impending tamponade. (Level of Difficulty: Advanced.).

Keywords: CMR, cardiac magnetic resonance; ECG, electrocardiogram; LV, left ventricular; RA, right atrial; RV, right ventricular; cardiac magnetic resonance; constrictive pericarditis; echocardiography; hemodynamics; imaging; pericardial effusion; right-sided catheterization; tamponade.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Transthoracic Echocardiogram (A) Reversed apical 4-chamber view with pericardial effusion (asterisk) and right atrial collapse (arrow). (B) Parasternal long-axis view with right ventricular collapse (arrow). (C) Parasternal short-axis view with right ventricular collapse (arrow). (D) Plethoric inferior vena cava. (E and F) Tricuspid (significant respiratory variation; arrowheads mark inspiration) and mitral inflow velocities.
Figure 2
Figure 2
Electrocardiograms (A) Pre-pericardiocentesis. (B) Post-pericardiocentesis.
Figure 3
Figure 3
Right-Sided Heart Catheterization With Equal and Elevated Diastolic Pressures (A) Right atrial (RA) pressure. (B) Right ventricular (RV) pressure. (C) Pulmonary artery (PA) pressure. (D) Pulmonary capillary wedge pressure (PCWP). Spo2 = peripheral oxygen saturation.
Figure 4
Figure 4
Pericardiocentesis (A) Intrapericardial pressure pre-drainage. (B) Post-drainage. (C) Gold paint appearance. (D) Polarized light microscopy revealing cholesterol crystals (arrow) and foam macrophages (arrowhead). Spo2= peripheral oxygen saturation.
Figure 5
Figure 5
Cardiac Magnetic Resonance (A and B) Long- and short-axis images; homogeneous pericardial effusion (white arrows), right atrial diastolic inversion (black arrow). (C and D) Long- and short-axis T2 maps without evidence of myocarditis. (E and F) Long- and short-axis images without inflammation in the myocardium, visceral (black arrows), and parietal (white arrows) pericardium. (G and H) Long- and short-axis phase-sensitive inversion recovery images without pericardial enhancement. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
See this image and copyright information in PMC

References

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