Constrictive Pericarditis in a Patient With Relapsed Acute Myelogenous Leukemia After Allogeneic Bone Marrow Transplantation
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.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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