An alerting sign: Enlarged cardiac silhouette

Abstract

A 75-year-old-woman with a history of hypertension and left-lung lobectomy for a carcinoid tumor 10 years ago presented with a 2-week history of progressive cough, dyspnea, and fatigue. Her heart rate was 159 beats per minute with an irregularly irregular rhythm, and her respiratory rate was 36 breaths per minute. Her blood pressure was 140/90 mm Hg. Examination revealed decreased breath sounds and dullness on percussion at the left lung base, jugular venous distention with a positive hepatojugular refl ux sign, and an enlarged liver. Electrocardiography showed atrial fi brillation. Chest radiography (Figure 1) revealed

Chest

“…Familiarization with this sign would help reduce missing diagnosis of lesions. Most importantly, if suspicion is found on X-ray chest film, CT would be further suggested [45].…”

Cough as the sole manifestation of pericardial effusion

“…He described a 53-year-old woman who presented to the emergency room with progressive cough and dyspnoea of 2 weeks’ duration, preceded by flu-like symptoms and intermittent pleuritic chest pain, identified as idiopathic acute pericarditis with effusion and cardiac tamponade based on physical examination, ECG and echocardiography findings 5. More recently in 2015, Hamiel et al reported a 75-year-old woman who presented with progressive cough, dyspnoea and fatigue, diagnosed with malignant pericardial effusion caused by small lymphocytic lymphoma 4. Dyspnoea accompanied cough in both case reports, unlike our patient.…”