Description
A 73-year-old woman without a history of cardiovascular disease was admitted to the hospital with progressive dyspnoea on exertion during the past several weeks, bilateral lower extremity oedema, orthopnoea and paroxistic nocturnal dyspnoea. She lived a few metres away from a badly preserved building containing asbestos for 50 years. Estimated jugular venous pressure was 6+5 cm H2O, a pericardial friction rub was heard, bilateral basal lung crackles were present and symmetrical below-knee pitting oedema was seen. Probrain natriuretic peptide was 2304 pg/mL, and chest radiograph showed a globular cardiac silhouette and blunting of the costophrenic angles due to a small transudative pleural effusion containing benign mesothelial cells on cytological analysis. Transthoracic echocardiogram showed a large pericardial effusion with diastolic collapse of the right ventricle and a hypotransparent mass (4x1.6 cm) attached to the visceral pericardium in the right apex (video 1). Therapeutic pericardiocentesis was performed and cytological analysis of pericardial fluid demonstrated...
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