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(Circulation. 2004;109:e146-e149.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Constrictive Pericarditis in a Patient With Relapsed Acute Myelogenous Leukemia After Allogeneic Bone Marrow Transplantation

Raymond Wong, MBChB; Jean-Bernard Durand, MD; Mario A. Luna, MD; Daniel R. Couriel, MD; James L. Gajewski, MD

From the Departments of Blood and Marrow Transplantation (R.W., D.R.C., J.L.G.), Cardiology (J.-B.D.), and Pathology (M.A.L.), University of Texas M.D. Anderson Cancer Center, Houston, Tex.

Correspondence to James L. Gajewski, MD, Department of Blood and Marrow Transplantation, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 423, Houston, TX 77030. E-mail jgajewski@mail.mdanderson.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 43-year-old man presented with a month’s history of progressive dyspnea, orthopnea, and abdominal distension several months after having been diagnosed with relapsed acute monocytic leukemia after allogeneic bone marrow transplantation. His heart rate was 110 bpm, and blood pressure was 120/50 mm Hg with peripheral edema. Heart sounds were normal. Chest x-ray showed a small right pleural effusion with clear lung fields and normal cardiac size. His renal function deteriorated rapidly, with a rise of creatinine from 2.8 to 4.3 mg/dL within 1 day after admission. Echocardiogram revealed an ejection fraction of 55% to 60%, a thickened pericardium, and a small pericardial effusion with respiratory variation on mitral inflow, which was suggestive of constrictive pericarditis (Figure 1). The pressure tracing of a left and right heart catheterization showed equalization of diastolic pressures between the left ventricle and right ventricle with dynamic respiratory variations (Figure 2). Pericardiectomy was planned, but the patient developed sudden cardiorespiratory arrest and failed resuscitation. Postmortem examination disclosed monocytic leukemia in tumoral phase involving practically every organ. The pericardium was markedly thickened with multiple, yellow-tan–colored nodules with an appearance resembling fish flesh, which measured up to 1 cm (Figure 3). Histology confirmed monocytic leukemic infiltration (Figure 4). Death was attributed to constrictive pericarditis secondary to leukemic infiltration.

View larger version (29K): [in this window] [in a new window]   Figure 1. A, Two-dimensional echocardiography done before transplantation (in October 2001) showing mild pericardial thickening. B, Two-dimensional echocardiography performed on admission with heart failure (April 2002), showing markedly thickened pericardium along . . . [Full Text of this Article]

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