Ahmed Taha Hussein
• Female patient 60 years old , widow ,not
DM nor HTN ,
• with relevant past history of cervical and
lumbar pain 1 year ago .
• Weight loss within 6 month.
• Co.: shortness of breathe since 4 month.
• the condition started 6 m ago by acute dyspnea
associated with cought and expectoration of
yellowish sputum and fever for 2 weeks .
• Later on the condition ameliorated with
• 1 m later the dyspnea recurred but was
progressive in nature and accompanied with dry
cough and pleuritic chest pain .
• Dyspnea progressed in orthopnea and
patient preferred the Prayer’s position .
• 1 week later patient developed periorbital
odeama progressed into generalised
odeama within 2 weeks .
• generalised boneache allover the body
especially the chest wall and vertebrae.
• Vital examination :
• Pulse : 100 Bpm regular thready pulse.
• Bl. Pr.: 90 / 70 .
• L.L : mild pitting oedema
• N.V. : congested pulsating up to ½ neck in 45*.
• Gereralised bony tenderness .
• No apparent Lymphadenopathy.
• Chest Examination :
– Dullness on percussion on the right side up to ½
– Diminished air entry on the right side .
• Cardiac Examination :
– Distant heart sounds , S4 .
• Low voltage
• Non specific T wave changes.
• CXR :
• Encysted pleural effusion
on the right side .
• Pleural wall thickening and
• Increased Bronchovascular
• Mild free peritoneal fluids.
• Within normal size liver and spleen.
• No masses or foci can be identified either
in the spleen or the liver.
• Within normal size and shape of both
According to the data of
investigations and clinical
Plasma protein Electrophoresis
• Albumin : 36%
• Alpha 1 : 2% polyclonal
• Alpha 2 : 8%
• Beta : 10%
• Gamma : 44%
• Diffuse band at
a failure of the right atrial pressure to decline by at least 50 percent
to a level below 10 mm Hg when
the pericardial pressure was reduced to near 0 mm Hg by pericardiocentesis
Take home message
• Systemic rare diseases are present and
should be in mind .
• Pericardium is emberyologically derived
from the same mesoderm as pleura and
• Even if the pathology is in the heart
,general body examination must be