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Pyopneumopericardium caused by mediastinal granuloma
Lorne J Gula1, Richard A Malthaner, Mackenzie A Quantz
1Division of Cardiology, London Health Sciences Centre, University of Western Ontario, Canada.
The Annals of Thoracic Surgery
|July 18, 2002
Summary
A rare case of pyopneumopericardium caused by granulomatous erosion from histoplasmosis is presented. Early imaging and mediastinal exploration are crucial for diagnosing and treating this life-threatening condition.
Area of Science:
- Cardiology
- Thoracic Surgery
- Infectious Diseases
Background:
- Pyopneumopericardium is a rare and life-threatening condition characterized by air and pus within the pericardial sac.
- Mediastinal masses, particularly those with infectious or granulomatous origins, can rarely erode into adjacent structures like the pericardium.
Observation:
- A previously healthy 32-year-old male presented with flu-like symptoms, dyspnea, and chest pain.
- Diagnosis of pyopneumopericardium was confirmed, with pericardial tap yielding 1.3 L of purulent material.
- Chest CT revealed a calcified subcarinal mass adherent to the esophagus and pericardium.
Findings:
- Surgical resection of the subcarinal mass was performed via right thoracotomy.
- Pathological examination identified granulomatous lymph nodes, strongly suggesting histoplasmosis as the etiology.
- The granulomatous process led to erosion into the pericardium, causing pyopneumopericardium.
Implications:
- This case highlights a unique presentation of histoplasmosis leading to pyopneumopericardium through granulomatous erosion.
- It underscores the importance of prompt diagnostic imaging, such as CT scans, for evaluating mediastinal abnormalities.
- Early surgical exploration is vital for managing pyopneumopericardium and identifying underlying causes, leading to favorable patient outcomes.