Pericardial Actinomycosis John Veinot Ottawa Hospital Ottawa, Ontario, Canada

Click here to download handout in 1-up pdf format for the current section (4.77 MB) Click here to download handout in 6-up pdf format for the current section (3.75 MB) Clinical History This middle age married male, 2 pack/ day smoker, had a recent diagnosis of systemic arterial hypertension. He presented with a flu like illness, fever, pleuritic chest pain and was treated for pericarditis with an NSAID. He presented to ER with chest pain, dyspnea, fever and an elevated JVP - query tamponade. Echo demonstrated a pericardial effusion and impending tamponade. The provisional diagnosis was viral pericarditis with tamponade. Repeat ECHO demonstrated an extrinsic mass extending from the pericardial space through the epicardium to the endocardium into RV cavity. CT of the chest confirmed the right ventricle mass and also showed multiple pulmonary nodules. The differential diagnoses entertained included TB, malignancy ? primary angiosarcoma or metastatic. TB testing was negative. Chemotherapy was planned so the oncologist wanted tissue to decide upon chemo type. A right ventricle endomyocardial biopsy was performed. Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Figure 1 160 mm Figure 2 RV endomyocardial biopsies