The outcome of „harmless” exudative pericarditis in a young patient: classic Hodgkin’s lymphoma – nodular sclerosis type

Introduction: Pericardial diseases are relatively common in clinical practice but the real incidence of them is difficult to appreciate because there are many cases undiagnosed. Men are usually more affected than women. It is mandatory to determinate whether this pathological condition is idiopathic or part of systemic diseases. The main types of pericardial diseases are of infectious or non-infectious causes.
Case presentation: A 35 years old non-smoker female was admitted to our department presenting dyspnea, precordial pain accentuated by deep breathing, subjective sensation of edema in the cervical area. Medical history revealed a respiratory infection two weeks ago, condition which required antibiotherapy. The objective examination outlines an infectious syndrome accompanied by biological confirmation through the reacting inflammatory markers. The blood cultures were positive for atypical bacteria, Mycoplasma Pneumoniae. The echocardiography reveals an important pericardial collection (19 mm) with swinging heart aspect and right ventricular collapse.
Although, the initial suspicion was plausible for an infectious context, the diagnostic and therapeutic algorithm changed considerably after performing the echocardiographic examination. An angio CT scan of the aorta was the next step in order to exclude the aortic dissection and allow the initiation of pericardiocente-sis. The evacuated pericardial effusion had hemorrhagic appearance and the presence of atypical cells reported the possibility of tumoral etiology, for these exudative pericarditis. The thoracic CT scanning represented an important element in managing this case since the presence of an expansive mediastinal mass invading the pericardium and upper cava vein, and aortic adenopathy, were revealed. The confirmation of the final diagnosis requested a mini-thoracotomy which described the Hodgkin\’s lymphoma aspect, nodular sclerosis type. We mention a slight improvement in dyspnea and inflammatory syndrome after the drainage of pericardial fluid. The patient was referred to the oncology ser-vice for initiating specialized treatment.
Conclusions: The most effective therapeutic management of pericarditis calls for the correct identification of the cause, responsible for the disease. Even though the entire clinical foundings leads to a final conclusion, we should always take into account the patient\’s symptoms. In our case, clinical symptoms relevant for a superior cervical vein syndrome and objective elements were validated by the suggestive echocardiographic appearance. The malignant etiology of pericarditis is a rare condition, but should be suspected even in young patients, if the clinical picture conveys suggestive elements. The most useful solution is to corroborate the information provided by specialized guidelines with clinical judgment to identify all the elements necessary for a correct diagnosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)