Palpitation dual side thoraxes uncomfortable in chest accumulate liquid _'s symptom

Palpitation, dual side thoraxes uncomfortable in chest accumulate liquid _'s symptom
Palpitation, dual side thoraxes uncomfortable in chest accumulate the liquid

Clinical and pathological magazine of experiment Vol. 15 of number 3 of 1999 Clinical pathology is discussed

Author: Hu should be smooth Zhang XiaoWen

Unit: Answer only recklessly ' Second affiliated hospital of south medical college of Anhui Dept. of pathology) (moustache should be only second dept. of pathology of the People's Hospital in Wuhu of now) 243000); Zhang XiaoWen ( Second affiliated hospital of south medical college of Anhui Internal medicine department)

Keyword: Fiedler myocarditis; In heart failure; Congestive; Septicemia; Autopsy

Classification numberR542.21The literature is annotated yardA

Article serial number1001-7399(1999) 03-0256-02

A case summary

The patient man, 24 years old. In cases there is no obvious inducement, palpitation, coughing for more than 20 days uncomfortable in chest of sense, there is no phlegm. Night sweat at night. Have not generated heat consciously and the chest aches, do not also have vomiting and popping dyspneal history at night. Receive difference, weak. Has gone to the local hospital to go to a doctor, symptom improves slightly after treating with penicillin. Admitted to hospital on July 22, 1989. The history is not special previously. Admitted to hospital the inspection: T 36.9 , P 116 times /divide,R 28 times /divide,BP 6.6/4.6 kPa. The spirit is clear, slight anaemia looks, the automatic body posture, the conjunctiva of eyelid, nail matrix are pale. Face, truck and slight edema of upper limbs. The simple table lymph node is not swelling, the neck is soft, the trachea is between two parties, the thoracic cage is symmetrical, the lung respiration is lowered slightly under right, there is no rale. Circle expand of heart left,HR 116 times /divide,neat in law, apex of the heart can hear in district and 2 grade SM noise. Unless unless flat soft in belly, it have tenderness, be be lasted pieced yeted,liver spleen (-) ,Two lower extremities( -). X-ray examination: Chest slice see heart circle expand, right thoraxes accumulate the liquid in a large amount, left thorax and abdominal cavity accumulate the liquid on a small quantity. The interesting Fig. of the supersound: Atrium sinistrum, ventricle internal diameter increase, the left heart function fails; Dual side thoraxes accumulate the liquid. EKG (July 25) : Sinus rhythm of the heart, V5, V6The wave changes, low-voltage. Check in the laboratory: RBC 4.0* 1012.L-1,Hb 120 g.L-1; WBC 4.6* 109.L-1,N 0.69, L 0.31; Blood ASO (-) ,LE cell ( -). Liver function is basically normal. The third bone marrow is normal. The chest is worn for the first time, the left thorax takes 140 ml liquid out, the right thorax takes 860 ml out as faint yellow liquid, Li all it ' -),Several 11.4* 10 cells6.L-1,The single core 0.65 is nuclear 0.35 much, albumen 0.298 g.L-1(basically similar through releasing the liquid to check repeatedly many times) ,Have not seen the cancer cell.

Through treatments to the ill such as strong heart, nutrition cardiac muscle, resisting tuberculosis,etc. after admitted to hospitalling, water of dual sides chest is absorbed for a time, symptom is improved. The body temperature rises to 37.8 on August 8, water of chest appears once again, and sense palpitation, symptom uncomfortable in chest are aggravated gradually, it cough it is red for foam last phlegm,hepatomegaly, rib 7 cms lower, neck be returned to to flow to solicit vein (+) . EKG shows on August 12: Sinus tachycardia, low-voltage, point out PV, negative value increases, the right ventricle is big, the cardiac muscle strains. Though treat with medicines such as diuresis, strong heart, expanding the blood vessel,etc., the result is not obvious, water of chest increases fast, the condition worsens, the appearance whole body edema continued. Lack the urine, the heartbeat of the afternoon of August 14, breathing to stop in the 13 afternoons of August.

2 is discussed clinically

Associate professor of treatment Zhang XiaoWenThis case has the following clinical characteristics: ( 1) Get up disease to be worried, course of disease short, from having illness coming on to death being only more than 40 days. ( 2) Patient's age is only 24 years old. ( 3) There are no medical history of important organ such as heart, liver, kidney, lung previously. ( 4) Mainly shown as palpitation, dual side thoraxes uncomfortable in chest accumulate the liquid, take right side as the core, hepatomegaly, the lower extremities have no edema. ( 5) A slice of suggestion cardiac dilatation of UCG, X-ray chest, take left heart as the core. Should consider the expanding myocardium disease at first according to the above-mentioned condition characteristics. Because patient have out of breath and dyspnea, whole body unable and face, truck, upper limbs edema, left heart expand and thorax accumulate liquid, hepatomegaly,etc., support this disease. Secondly the short, whole body of course of disease of an example is unable, face, truck and upper limbs edema, and there is going on cardiac enlargent and in heart failure, out of breath and having difficulty in breathing, so isolatism myocarditis also can't be got rid of. Drawing back narrow pericarditis though has smilarities, the lower extremities have no edema, there is not symptom of blocking etc., UCG does not also support, so does not consider. Malignant tumour such as alveolus cell cancer, because influence the gas dispersion function, often display and have difficulty in breathing clinically as the main fact, the patient once had for a time symptom was improved, so can't explain. Leather tumour under thorax, because chest the intersection of swimming skill and quality, X-ray, Ultrasonography B check, support, have chest ache symptom also. Primary heart tumour, clinical manifestation does not accord with. In a word, should consider expanding myocardium disease or isolatism myocarditis, it is depleted that the patient dies from many internal organs functions.

Associate professor of treatment Chen YiNianPatient's clinical manifestation is mainly that the heart declines, and run through in the whole course, so should consider diagnosing the primary expansion type developing type sharply of myocardium disease. This one type patient can cause the death in a short time, and produce water of a large number of chests, the albumen content of the intersection of chest and ink is low, cells can not be counted high, in order to leak liquid. So, I think a disease can explain the above-mentioned clinical manifestation more satisfactorily.

Hu Chang defeats the associate professor of treatment The patient once had one upward swing after being admitted to hospital, can't explain with malignant tumour. Can inhibit golden yellow staphylococcus while employing rifampin, so SBE should be considered.

Associate professor of treatment Pan WeiRenIt is very difficult with the single disease mechanism to explain a disease satisfactorily, I consider the expanding myocardium disease this diagnosis is established, cover tumour is possible among amalgamating tuberculosis or pleura of whole body on this basis.

Check to the expensive peach chief physicianAccording to medical history and clinical manifestation, I agree myocardium disease of expanding etc., person who develop or diagnosis of myocarditis sharply.

Chief physician Chen ShuShiSeen from symptom a lot of respects have not supported to draw back narrow pericarditis to diagnose, so can get rid of. Heart tumour is rare, such as for then sending heart tumour, where to send the cooking stove originally? Easy to be explain without being improved symptom for a time to have once,so heart tumour but except. This case briefs us on to some extent, the heart declines patients and produces water of chest, it can be one side, also can be dual sides. So I think the primary expansion type myocardium disease, developing type or myocarditis comparatively accords with sharply.

3 autopsy reports

Male corpse, height 165 cm, face department and slight edema of the upper limbs, four limbs are terminal livid purple, the lower extremities have no edema, it is dyed that the skin is not yellow all over. The left thorax accumulates the liquid 100 ml, the right thorax accumulates the liquid 140 ml, the pericardium accumulates liquid 120 ml, the abdominal cavity accumulates the liquid 410 ml, yellowish. Heart serious 680 g, the appearance is obviously expanded and taken the form of calabash, cuts off the competent route of blood, see left and right heart tunes and trunks congeal the clot in a large amount inside, left and right auricle enclose wall to be thrombotic and 0.2- 0.5 cm loud about 4, atrium sinistrum, right ventricle are slightly expanded, the tricuspid valve can not be relatively closed completely. The wall thick 0.2 cm of atrium dextrum, the wall thick 1.0 cm of right ventricle, the wall thick 0.4 cm of atrium sinistrum, left ventricular wall thick 1.3 cm, the heart is slightly expanded, the bicuspid valve can be closed. Every valve cross-section diameter is basically normal, have not seen the superfluous living beings.

Two lungs value 1 600 g, the tangent plane is relatively real, few foam a kind of liquid is pushed out of. Liver spleen extravasated blood, kidney and other internal organs have not been seen unusually. The meninx is congested, but not seen the cooking stove of infarction of brain and bled.

Under the mirror: Unless among cardiac muscle quality edema, it is fibrous master cell and blood vessel hyperplasias little,come loose quantity lymphocyte, plasma cell, monocyte and a few grains of cells neutrals medium-sized in or cooking stove infiltration, it is very around the small blood vessel. Some cardiac muscle presents solidifying necrosis, the small fibrous cooking stove takes shape. The second lung extravasated blood is obvious, there is hydropic liquid in the alveolus, see that declines cells more suspiciously. The small leaf of some lungs, regard thin bronchus as the centre, the neutral cells of a large number of are soaked, form small abscess. Detailed bronchus, alveolus of pathological change are full of slurries and ooze out thing, neutral corn cell, suppuration cell and loss the upper skin (Fig. 1 inside- 4). There is a plurality of small abscess that takes shape in one pair of kidney essences. The brain edema, there is little abscess under the hard meninx, but not seen thromboembolism and infarction cooking stove. See a plurality of little abscess in the liver essence; Spleen and intestines and stomach extravasated blood, other internal organs have not been seen unusually. Corpse examine the energies train ' 13 h goes on after dying) ; Golden yellow staphylococcus grows.



Among cardiac muscle of Fig. 1 the mess for medium-ranking cadres of the quality or distribute and soak in the lymphocyte, plasma cell and neutral cells of small quantity. HE* 100



Quality edema of sweetheart of Fig. 2, cooking stove neutral cells and lymphocyte are soaked. HE* 200



Small abscess in lung of Fig. 3. HE* 40



Small abscess in lung of Fig. 4. HE* 200

Pathological diagnosis: ( 1) Fiedler myocarditis (isolatism myocarditis, the inflammation type of filling a quality) Continue the hair: Control the ventricle ' Slightly) Expand, the tricuspid valve can not be relatively locked completely. Congestive and in heart failure and two auricles enclose the thrombosis of wall. Second lung extravasated blood edema. Thorax, pericardium, peritoneum accumulate liquid.

( 2) The second lung bronchus pneumonia erupts golden yellow staphylococcus suppuration poisonous blood disease and a pair of kidney, brain, liver occuring frequently small abscess simultaneously.

Death reason: Depleted whole-heartedly, suppuration and poisonous blood disease.

4 pathology is discussed

Hu should be only attending physician ' Dept. of pathology) Fiedler myocarditis, proposed at first, meant originally it was in heart failure and cause urgent extremely myocarditising with going on nature that the acute cause of disease was unidentified in 1899 for Fiedler. Jaffe thinks, isolatism myocarditis is a response of the quality among the same type cardiac muscle that different reasons cause. Think now, Fiedler myocarditis is a kind of non- specific myocarditis, may be infected a kind of breaking out myocarditis caused by Coxsachie B clan virus. Corpse examine pathological change involve cardiac muscle mainly, show as muscle fibre have a large number of lymphocytes, plasma cells soaked. Pathologic morphology divide the intersection of Fiedler and myocarditis into two type: Namely the filling the air type and the granulation is swollen type. This example belongs to the filling the air type. The course of disease of this kind of myocarditis is relatively very brief, this example is only more than 40 days from having illness coming on to death.

5 diagnosis and differential diagnosis

This disease mainly displays the quality edema among the cardiac muscle with inflammation pathological change of the cardiac muscle, the lymphocyte, plasma cell, monocyte are soaked as its characteristic. With the failing of heart function, can expand compensatory hypertrophy of heart and heart, this example has left hearts that declines first, causes pulmonary vein extravasated blood, in addition, bronchus pneumonia, artery pressure of lung increase, cause the right heart to decline, the right ventricle to expand, so the left and right ventricle of an example is expanded, the tricuspid valve can not be relatively locked completely.

While diagnosing a disease, need to distinguish with the following heart disease:

( 1) Check: Chest slice see heart circle expand, right thoraxes accumulate the liquid in a large amount, left thorax and abdominal cavity accumulate the liquid on a small quantity. The interesting Fig. of the supersound: ( 1) Atrium sinistrum, ventricle internal diameter increase, the left heart function fails, because of myocarditis while pointing out patients and is admitted to hospital, myocardium contractile force is weakened, there are left heart depleted functions. Through strong heart, diuresis after admitted to hospitalling, treats effectively to the ill,etc., the function part resumes the cardiac muscle's shrinking, so once had for a time hearts declined symptom to relieved. Because erupt bronchus pneumonia simultaneously on August 8, the body temperature rises to 37.8 , amalgamate suppuration and poisonous blood disease, cause and press and increase in the lung, make the resistance behind the heart further increase, it is depleted to present the heart function once again, so palpitation, symptom such as being uncomfortable in chest aggravate, cough getting pink foam glues the phlegm, because the left heart declines then causes the right heart to decline, display hepatomegaly, the intersection of neck and vein, return to, shed, solicit ' +) Wait for symptom, end because decline whole-heartedly, the intersection of suppuration and malicious the intersection of blood and disease and death.

Author's profile: Hu should only, male, 40 year old, attending physician

Accept draft date: 1999-01-11
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