No abstract

Más del 50% de los derrames pericárdicos en pacientes oncológicos son debidos a otro proceso no maligno y por tanto es fundamental establecer la causa por sus connotaciones pronósticas y terapéuticas. La ecocardiografía transtorácica es la técnica de elección para la valoración del pericardio, pero en ocasiones la imagen multimodal puede ayudar. La tomografía computarizada (TC) ha surgido como una alternativa para determinar la cantidad y distribución del líquido y caracterizar los engrosamientos, masas y el propio líquido pericárdico, por lo que aporta información útil para determinar su etiología y guiar su drenaje. A través de un caso clínico, repasaremos brevemente la utilidad de la TC en la enfermedad pericárdica.

Es relativamente frecuente encontrar hallazgos extracardíacos en la ecocardiografía transtorácica. Se presenta un caso clínico en el que la ecocardiografía “rutinaria” por pericarditis permitió hacer el diagnóstico de un absceso hepático y resolver el problema del paciente. Este caso demuestra la importancia de prestar atención a todo lo que se pueda ver en la imagen de la ecocardiografía

Anthracyclines (anth) are potent antineoplasic agents, although, their efficacy is limited by cardiotoxicity. Most lymphoid malignancies tend to recur and commonly require anthracycline-based chemotherapy (anth-bch) re-treatment. Our aim is to compare the pretreatment left ventricle ejection fraction (lvef) and global longitudinal strain (gls) between patients (pts) with new diagnosis of lymphoma (lym) and pts with lym recurrence that were treated previously with anth-bch. Among pts referred to assess lvef and gls prior to start ttm, lym patients were selected and divided in two groups: pts with recurrent lymp previously treated with anth and pts with new diagnosis of lymp. Patients data, lvef and gls values were collected retrospectively. 96 pts data were analyzed (see table): 23 pts (24%) with previous anth ttm and 73 newly diagnosed pts. No differences were found in baseline characteristics. Pts who previously had been treated with anth-bch demonstrated significantly lower lvef than the other group and there were more patients with lvef in the normal lower limit. Gls was also lower but the difference was not significant. The fact that gls was not calculated in all patients may explain this finding. No differences were found in diastolic function. Previous cardiotoxic ttm and lower limit of normal lvef have been described as patient-related risk factors for developing cardiotoxicity. Currently, previous cardiotoxicity risk assessment is critical to allow preventive measures. Cardio-oncology units are crucial to address cardiovascular (cv) needs of cancer patients. * p < 0.05 Previous anthracycline No previous anthracycline p n (%) 23 ( 24 %) 73 ( 76%) Women, n (%) 9 (39%) 34 (47%) 0,31 Age (m +/- SD) 66,2 +/- 14,6 63,2 +/- 17,4 0,44 Arterial hypertension, n(%) 8 (35%) 26 (36%) 1 Diabetes, n (%) 5 (22%) 8 (10%) 0,29 Dyslipidemia, n (%) 7 (30%) 28 (37%) 0,62 ACE inhibitor, n (%) 2 (8,7%) 4 (5,5%) 0,62 Betablokers, n (%) 5 (22%) 19 (26%) 0,78 FEVI (Simpson)*, m +/- SD 57,3 +/- 7 62,7 +/- 6 0,0007 GLS -19,3 +/- 3 -20,2 +/- 3,7 0,52 LVEF < 55%* 5 (22%) 4 (5,5%) 0,03 Comparison between lymphoma patients treated previuosly with antrhacycline and with no previous cardiotoxic treatment.

We report the case of a 71-year-old man, without any previous history of cardiovascular disease, who was derived to our echocardiography laboratory because of a six-month period of dyspnoea. In the echocardiographic examination, various pleural masses which depended from the left visceral pleura were found, surrounded by, what it seemed, an abnormally located severe anterior pleural effusion, which caused left lung atelectasis (jellyfish sign, complete atelectasis of a lung lobe which floats above a massive pleural effusion) with a less important pericardial effusion (Figure 1). After the echocardiographic findings, a total body Computed Axial Tomography (CAT) scan and a Positron Emission Tomography (PET) were performed, confirming various left pleural implants and a severe left pleural effusion causing a big left lung atelectasis with widespread cervical, thoracic and abdominopelvic adenophaties, suggestive of advanced lymphoma. The cytological exam of the pleural liquid obtained by the thoracentesis procedure, showed a monotonous population of predominantly medium size cells with signs of nuclear indentation compatible with a pleural affection by a germinal center follicular lymphoma. Pleural effusion is a common complication of lymphomas (20-30%) and is considered as one of the factors adversely influencing overall survival, as in most of the cases, serous cavity involvement is part of a disseminated disease process. The thoracic duct obstruction and impaired lymphatic drainage appear to be the primary mechanism for pathogenesis of pleural effusion in Hodgkin´s disease and direct pleural infiltration is the predominant cause in non-Hodgkin´s lymphoma. Because the descending thoracic aorta is interposed between the pericardium anteriorly and the pleura posteriorly, echocardiography may be a useful landmark in the differentiation of posterior effusions. However, sometimes due to the abnormal position of the effusion, it might be difficult to differentiate between pericardial and pleural effusions, with the need, as in our case, to perform a multi-modality imaging study with a CAT and PET scan, followed by a cytological exam, to confirm the diagnosis and to guide the posterior treatment. Finally, we would like to underline the importance of familiarizing ourselves on the basics of pulmonary echocardiography, as these findings are frequent during the performance of echocardiography in our daily practice. Abstract P1735 Figure. Jellyfish sign in pleural effusion