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[Pericardial involvement in Hodgkin's disease]
S Kotlarek-Haus1, L Usnarska-Zubkiewicz, H Nowosad
1Katedry i Kliniki Hematologii, Oddział Diagnostyki Kardiologicznej Kliniki Chirurgii Serca.
Insights
Pericardial effusion, a sign of advanced Hodgkin's disease (HD), was observed in patients with larger mediastinal masses and lower T lymphocyte counts. This effusion often resolved with chemotherapy, indicating it stems from the disease itself.
Area of Science:
- Cardiology
- Oncology
- Hematology
Background:
- Hodgkin's disease (HD) is a cancer of the lymphatic system.
- Pericardial effusion (PE) is the abnormal accumulation of fluid around the heart.
- The relationship between HD, mediastinal mass, and PE requires further investigation.
Purpose of the Study:
- To investigate the incidence and characteristics of pericardial effusion in patients with newly diagnosed Hodgkin's disease.
- To correlate pericardial effusion with clinical stage, mediastinal mass size, and T lymphocyte counts.
- To assess the impact of polychemotherapy on pericardial effusion in HD patients.
Main Methods:
- Echocardiographic examinations were performed before and after polychemotherapy in 21 consecutive Hodgkin's disease patients.
- Clinical staging, mediastinal mass assessment, and T lymphocyte counts were analyzed.
- Comparison was made between patients with and without pericardial effusion.
Main Results:
- Five patients (24%) developed pericardial effusion, with one showing epicardial infiltrate.
- Patients with PE had advanced clinical stages (IVB, IIIB) and significantly larger mediastinal masses compared to those without PE.
- A statistically significant decrease in T lymphocytes was observed in the PE group.
Conclusions:
- Pericardial effusion in Hodgkin's disease is associated with advanced disease, larger mediastinal tumors, and compromised T lymphocyte levels.
- The resolution of PE after chemotherapy suggests it is a manifestation of the underlying disease rather than an independent cause.
- Echocardiography is valuable for detecting and monitoring cardiac involvement in Hodgkin's disease.
Abstract:
In 21 consecutive patients with recently diagnosed Hodgkin's disease echocardiographic examination was carried out before and after subsequent courses of polychemotherapy. In 5 persons more than physiological amount of pericardial fluid was found and additionally, in one of them an infiltrate of the epicardium. IVB clinical stage of HD was diagnosed in three pts and III B in two, what was substantially different from the findings in 16 patients without pericardial effusion (PE), where 50% had favourable clinical stages IIA-IIIA. All patients with PE disclosed a mediastinal mass greater in two than 1/3 of maximal width of the thorax, whereas in the group without BE mediastinum involvement was only found in 9/16 pts: in no case it was of bulky size. Out of laboratory findings a statistically significant decrease in T lymphocytes in the group with PE in comparison with that without is to be stressed which in turn showed significantly lower values than healthy subjects. The disappearance of PE after 1-2 courses of chemotherapy is in favour of the opinion of authors that pericardial involvement resulted from the underlying disease itself, not from an other cause.