New Horizons in Clinical Case Reports最新文献

英文中文

Tracheoesophageal fistula in sibilings - A rare occurence 气管食管瘘在兄弟姐妹-罕见的发生

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.153

Hind Zaidan *, Hussein Hamdy, Martin Corbally

Introduction

Esophageal atresia is one of the most common congenital malformations occurring in 1 in every 2000-4000 live births. Previously considered to be a fatal condition, it has now become an eminently treatable condition with survival limited only by the presence or absence of major cardiac malformations. For the majority of families, the condition is unique to one child which in itself is challenging. It is extremely rare to affect more than one sibling in any family. The risk of recurrence is 0.5-2% and rises to 20% if another sibling is affected.

Case description

We report on two siblings, born two years apart with Type C TOF who were treated at King Hamad University Hospital, Bahrain. The first sibling was born with a short gap esophageal atresia with a distal fistula and repaired shortly after birth in another institution. The second sibling was born with a more challenging long gap esophageal atresia also with a distal fistula. The fistula was ligated on the second day of life and a gastrostomy tube put in place for feeding; repair of the atresia took place 2 months later. Both patients underwent serial dilatations to overcome strictures but are both tolerating oral diets. The third sibling in the family was unaffected with TOF or any VACTREL association.

Conclusion

The etiology of TOF is multifactorial with genetic, environmental and unknown components. There were no known environmental factors which could have contributed to this rare occurrence, but the only factor of significance is consanguinity of the parents who are first cousins. On the other hand, genetic factors are responsible for 12% of cases, these are classified as Chromosomal mutations, Syndromic or Isolated. These siblings do not fall into any of the mentioned categories and it is therefore speculated that this occurrence is due to a sporadic mutation.

Take-home message

Esophageal atresia with or without fistula is a fairly common condition encountered by paediatric surgeons on a daily basis. Despite increased experience and advancements in management of complex cases, the etiology remains a mystery. Future research should focus on more in-depth genetic studies on the impact of co-sanguinity on sibling TOFs.

食管闭锁是最常见的先天性畸形之一，每2000-4000例活产婴儿中就有1例。以前被认为是一种致命的疾病，现在已经成为一种明显可治疗的疾病，生存仅受主要心脏畸形的存在或不存在的限制。对于大多数家庭来说，这种情况是一个孩子独有的，这本身就是一个挑战。在任何家庭中，影响一个以上兄弟姐妹的情况极为罕见。复发率为0.5-2%，如果另一个兄弟姐妹受到影响，复发率会上升到20%。病例描述:我们报告了在巴林哈马德国王大学医院治疗的两兄弟姐妹，出生时年龄相差两岁，患有C型TOF。第一个兄弟姐妹出生时患有短间隙食管闭锁伴远端瘘，出生后不久在另一家机构进行了修复。第二个兄弟姐妹出生时患有更具挑战性的长间隙食管闭锁，也患有远端瘘。在出生的第二天结扎瘘管，并放置胃造口管进行喂养;2个月后进行闭锁修复。两名患者均接受了连续扩张以克服狭窄，但均耐受口服饮食。家族中的第三个兄弟姐妹未受TOF或任何VACTREL关联的影响。结论TOF的病因是多因素的，有遗传因素、环境因素和未知因素。没有已知的环境因素可能导致这种罕见的现象，但唯一重要的因素是父母的近亲关系。另一方面，遗传因素占12%的病例，这些病例被分类为染色体突变、综合征或孤立性。这些兄弟姐妹不属于上述任何类别，因此推测这种发生是由于散发性突变。带回家的信息食管闭锁伴或不伴瘘是儿科外科医生每天都会遇到的一种相当常见的情况。尽管在复杂病例管理方面的经验和进步有所增加，但病因仍然是一个谜。未来的研究应该集中在更深入的遗传学研究上，研究同血缘对兄弟姐妹tof的影响。

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引用次数: 1

Post-infarction left ventricular pseudoaneurysm 梗死后左室假性动脉瘤

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.194

Rienzi Diaz *

Introduction

Pseudoaneurysm of the left ventricle is a severe complication of myocardial infarction that results from a free cardiac wall rupture that is contained by the pericardium, thrombus, or adhesions. Most patients with a cardiac pseudoaneurysm will display symptoms of dyspnea or chest pain, but 10% of patients can be asymptomatic. Transthoracic Doppler color flow imaging is a suitable starting diagnostic method for diagnosing a pseudoaneurysm of the left ventricle. Cardiac magnetic resonance is an excellent complementary method for identifying this cardiac entity.

Case description

A patient in heart failure was admitted to receive intensive care therapy. An electrocardiogram showed anterolateral ST elevation and two-dimensional echocardiogram [2DE] posterolateral akinesis of the left ventricle. After a satisfactory in-hospital course he was discharged without any apparent complication. Six months later he was referred for new evaluation due to heart failure symptoms. A 2DE revealed a pseudoaneurysm along the left ventricular lateral wall. A cardiac magnetic resonance confirmed a pseudoaneurysm contained by the pericardium. Late gadolinium-enhanced imaging demonstrated a transmural lateral myocardial infarction with marked delayed enhancement of the pericardium that forms the wall of the pseudoaneurysm.

Results and conclusions

Early surgical intervention is recommended for a pseudoaneurysm of the left ventricle because of its tendency to rupture. Most patients do well after surgical repair, except for that requiring concomitant mitral valve replacement. However, the long-term outcomes of patients with a pseudoaneurysm not treated with surgery appear to be relatively benign, with a very low risk of fatal rupture. Therefore, a conservative approach may be considered in these patients that should include chronic anticoagulation therapy because of a high risk of ischemic stroke.

Take-home message

Transthoracic echocardiography is an acceptable starting diagnostic method in patients having a pseudoaneurysm. Cardiac magnetic resonance has been increasingly used as a non-invasive diagnostic method.

左心室假性动脉瘤是心肌梗死的一种严重并发症，由心包、血栓或粘连引起的游离心壁破裂引起。大多数心脏假性动脉瘤患者会出现呼吸困难或胸痛的症状，但10%的患者可能无症状。经胸多普勒彩色血流显像是诊断左心室假性动脉瘤的一种合适的起始诊断方法。心脏磁共振是识别这种心脏实体的一种极好的补充方法。一例心力衰竭患者入院接受重症监护治疗。心电图显示前外侧ST段抬高，二维超声心动图[2DE]显示左心室后外侧运动。经过满意的住院治疗后，他出院了，没有任何明显的并发症。6个月后，由于心衰症状，他被转介进行新的评估。2DE显示左心室外侧壁有假性动脉瘤。心脏磁共振证实心包膜内有假性动脉瘤。晚期钆增强成像显示为跨壁外侧心肌梗死，形成假性动脉瘤壁的心包明显延迟强化。结果与结论左心室假性动脉瘤易破裂，建议早期手术治疗。大多数患者手术修复后恢复良好，除了需要合并二尖瓣置换术的患者。然而，假性动脉瘤患者不接受手术治疗的长期结果似乎是相对良性的，致命破裂的风险非常低。因此，由于缺血性卒中的高风险，这些患者可以考虑采用保守方法，包括慢性抗凝治疗。经胸超声心动图是假性动脉瘤患者可接受的起始诊断方法。心脏磁共振作为一种非侵入性的诊断方法已被越来越多地使用。

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引用次数: 0

Neurocysticercosis presenting with psychosis 神经囊虫病表现为精神错乱

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.188

Aml ElemamaliI *, Shafa Talyb, Abobaker Awad

Introduction

Neurocysticercosis, the infection caused by the larval form of the tape worm Taenia Solium is the most common parasitic disease of the central nervous system. The disease presents it with spectrum of clinical manifestations like seizure, headache, neurological deficit and psychiatric symptoms such as psychosis. Even though most commonly patients present with seizure, rarely it may produce symptoms of neuropsychiatric disorder such as psychosis.

Case description

Here we are going to report a case of a patient 31-year-old Nepali male who presented to our emergency department with features of acute psychosis. Later on with diagnostic imaging like CT head and MRI brain was discovered to have multiple neurosysticercosis one in the right frontal region and the other in the right inferior cerebellar region. Patient was admitted to the inpatient and was managed with anthelminthic, antipsychotic and steroids.

Results and conclusions

Patient condition improved and he is on regular follow up in psychiatry and neurology clinic.

Take-home message

Although it is rare for neurocysticercosis to present with psychosis, always keep a high index of suspicion especially in patients from endemic areas.

神经囊虫病是由带绦虫幼虫形式引起的感染，是最常见的中枢神经系统寄生虫病。该病的临床表现有癫痫、头痛、神经功能障碍和精神病等精神症状。尽管大多数患者通常表现为癫痫发作，但很少会产生神经精神障碍的症状，如精神病。病例描述在这里，我们将报告一例31岁尼泊尔男性患者，他以急性精神病的特征来到我们的急诊科。后来，通过CT头部和MRI脑部的诊断成像，发现多发神经系统尾蚴病，一个在右侧额叶区，另一个在右侧小脑下区。患者被收住住院并给予驱虫药、抗精神病药和类固醇治疗。结果与结论患者病情好转，在精神科和神经科门诊定期随访。虽然神经囊虫病很少出现精神症状，但始终保持高度的怀疑指数，特别是来自流行地区的患者。

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引用次数: 0

One center experience of pneumatosis cystoides intestinalis 肠囊性肺肿的一个中心经验

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.195

V. Mokricka, Polina Zalizko, M. Pavărs, A. Āboliņš, A. Puķītis

引用次数: 0

Reduced GO/NOGO ACC-sensitive Activity in A Case of Parkinson's Disease with Impulse Control Disorders 帕金森氏病伴冲动控制障碍的GO/NOGO acc敏感活性降低

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.155

S. Palermo, R. Morese, M. Zibetti, Francesca Dematteis, Maria ConsueloValentini, L. Lopiano

引用次数: 0

Diffuse colon polyposis unexpected, total regression due to combined treatment on liver metastasis 原发性弥漫性结肠息肉病，经肝转移联合治疗后完全消退

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.196

Zsanett Bíró, A. Papp, Ö. Horváth, A. Vereczkei

引用次数: 0

Partial Priapisim: A rare presentation of sickle cell anemia 镰状细胞性贫血的一种罕见表现

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/J.NHCCR.2017.06.156

M. Malallah, Hussain Al Rashed, Abdullatif Al Terki, Tariq Al Shaiji

引用次数: 0

Acute renal failure and severe lactic acidosis due to metformin 二甲双胍引起的急性肾功能衰竭和严重乳酸酸中毒

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.167

Sirmpilantze Tamta * , Kordali Christina , Poulas Andreas , Charalambous Natasa , Lambas Vaggelis , Rozi Fotini , Mavras Georgios , Lampropoulos E Christos

Introduction

Metformin may rarely cause lactic acidosis in patients with predisposing factors of acidosis or tissue hypoxia, like acute renal or heart failure, liver failure, dehydration, alcohol consumption or serious infection. Mortality may approach 50% in these cases.

Case description

A 70-year-old lady came to the emergency unit because of vomits and diffuse abdominal pain. Five days ago, she had visited our hospital for the same reason, with normal findings on physical and laboratory examination. Her medical history included diabetes mellitus under metformin/vildagliptin and dementia. The patient was confused and disoriented, afebrile, oliguric, with tachypnea and diffuse abdominal tenderness. Pressure was 130/70mmHg. Blood gases revealed severe lactic acidosis (lactate>15mmol/L), pH=6.84, PCO₂=7mmHg, pO2=133mmHg, glucose=57mg/dL, HCO3<3mmol/L. Abnormal laboratory tests included creatinine=5.3mg/dL, urea=152mg/dL, WBC=17000/µL, hemoglobin=12.3gr/dL, sodium=133mmol/L, potassium=4.4mmol/L, ESR=43mm/h. Chest x-ray, abdominal ultrasound (to exclude obstructive nephropathy) and echocardiography were normal.

Results and conclusions

The patient received 400mL bicarbonate 4.8%, aggressive hydration, dopamine (diuretic dose) and 160mg furosemide. Because of clinical deterioration she underwent hemodialysis. She was treated, according to guidelines, as for severe sepsis with meropenem. Blood and urine cultures were negative. On 1^st day, ECG showed ischemic lesions, which resolved with nitrates. Abdominal CT was normal. She remained afebrile after the 1^st day (low grade fever). Overall, the patient underwent three hemodialysis sessions (resistant severe lactic acidosis, low bicarbonates). On 2^nd day, she was well oriented. She was discharged 8 days later with urea=59mg/dL and creatinine=1.6mg/dL. After 20 days, creatinine was 1mg/dL.

Take-home message

Metformin may be a cause of severe lactic acidosis, disproportionate to the degree of renal failure, in patients with previous normal renal function and acute dysregulation. Hemodialysis is a lifesaving therapeutic intervention in these patients.

有酸中毒或组织缺氧易感因素的患者，如急性肾或心力衰竭、肝功能衰竭、脱水、饮酒或严重感染，二甲双胍很少引起乳酸性酸中毒。这些病例的死亡率可能接近50%。病例描述一位70岁的女士因呕吐和弥漫性腹痛来到急诊科。5天前因同样原因来过我院，体检和化验结果正常。她的病史包括二甲双胍/维格列汀治疗下的糖尿病和痴呆。病人神志不清，神志不清，发热，少尿，呼吸急促，腹部弥漫性压痛。血压130/70mmHg。血气显示严重乳酸性酸中毒(乳酸15mmol/L)， pH=6.84, PCO2=7mmHg, pO2=133mmHg，葡萄糖=57mg/dL, hco3 = 3mmol/L。实验室检查异常:肌酐=5.3mg/dL，尿素=152mg/dL, WBC=17000/µL，血红蛋白=12.3gr/dL，钠=133mmol/L，钾=4.4mmol/L, ESR=43mm/h。胸片、腹部超声(排除阻塞性肾病)和超声心动图均正常。结果与结论患者给予碳酸氢盐400mL 4.8%，积极水合，多巴胺(利尿剂量)，速尿160mg。由于临床恶化，她接受了血液透析。根据指南，她接受了美罗培南治疗严重败血症的治疗。血和尿培养均为阴性。第1天心电图显示缺血性病变，硝酸缓解。腹部CT正常。第1天后患者仍无发热(低烧)。总的来说，患者进行了三次血液透析(抵抗严重乳酸酸中毒，低碳酸氢盐)。第二天，她已经适应了。8 d后出院，尿素59mg/dL，肌酐1.6mg/dL。20 d后，肌酐为1mg/dL。结论:二甲双胍可能是导致严重乳酸酸中毒的原因，与肾功能衰竭的程度不成比例，在以前肾功能正常和急性肾功能失调的患者中。对这些患者来说，血液透析是一种挽救生命的治疗干预。

{"title":"Acute renal failure and severe lactic acidosis due to metformin","authors":"Sirmpilantze Tamta * , Kordali Christina , Poulas Andreas , Charalambous Natasa , Lambas Vaggelis , Rozi Fotini , Mavras Georgios , Lampropoulos E Christos","doi":"10.1016/j.nhccr.2017.06.167","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.06.167","url":null,"abstract":"<div><h3>Introduction</h3><p>Metformin may rarely cause lactic acidosis in patients with predisposing factors of acidosis or tissue hypoxia, like acute renal or heart failure, liver failure, dehydration, alcohol consumption or serious infection. Mortality may approach 50% in these cases.</p></div><div><h3>Case description</h3><p>A 70-year-old lady came to the emergency unit because of vomits and diffuse abdominal pain. Five days ago, she had visited our hospital for the same reason, with normal findings on physical and laboratory examination. Her medical history included diabetes mellitus under metformin/vildagliptin and dementia. The patient was confused and disoriented, afebrile, oliguric, with tachypnea and diffuse abdominal tenderness. Pressure was 130/70mmHg. Blood gases revealed severe lactic acidosis (lactate>15mmol/L), pH=6.84, PCO<sub>2</sub>=7mmHg, pO2=133mmHg, glucose=57mg/dL, HCO3<3mmol/L. Abnormal laboratory tests included creatinine=5.3mg/dL, urea=152mg/dL, WBC=17000/µL, hemoglobin=12.3gr/dL, sodium=133mmol/L, potassium=4.4mmol/L, ESR=43mm/h. Chest x-ray, abdominal ultrasound (to exclude obstructive nephropathy) and echocardiography were normal.</p></div><div><h3>Results and conclusions</h3><p>The patient received 400mL bicarbonate 4.8%, aggressive hydration, dopamine (diuretic dose) and 160mg furosemide. Because of clinical deterioration she underwent hemodialysis. She was treated, according to guidelines, as for severe sepsis with meropenem. Blood and urine cultures were negative. On 1<sup>st</sup> day, ECG showed ischemic lesions, which resolved with nitrates. Abdominal CT was normal. She remained afebrile after the 1<sup>st</sup> day (low grade fever). Overall, the patient underwent three hemodialysis sessions (resistant severe lactic acidosis, low bicarbonates). On 2<sup>nd</sup> day, she was well oriented. She was discharged 8 days later with urea=59mg/dL and creatinine=1.6mg/dL. After 20 days, creatinine was 1mg/dL.</p></div><div><h3>Take-home message</h3><p>Metformin may be a cause of severe lactic acidosis, disproportionate to the degree of renal failure, in patients with previous normal renal function and acute dysregulation. Hemodialysis is a lifesaving therapeutic intervention in these patients.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"1 ","pages":"Page 15"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.06.167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gastrointestinal metastases from breast cancer: A case report 乳腺癌胃肠道转移1例

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.199

Begoña Peinado, Estibaliz Álvarez, Isabel Pascual, Ines Rubio, Mario Alvarez, Jose Luis Marijuan, Joaquin Diaz

Background

Breast cancer is the most common type of cancer in women nowadays. According to published major studies, the most common sites of metastases of breast cancer are bone, lung, liver and brain. However, it can also metastasize rarely to the gastrointestinal tract. Among the different subtypes of breast cancer, gastrointestinal spread has been associated to infiltrating lobular carcinoma. We present a case of perforated acute diverticulitis that underwent surgery, in which the pathological exam informed of colonic metastasis of lobular breast carcinoma.

Case report

A 78-year-old woman, with medical history of high blood pressure, diabetes and left mastectomy performed 14 years ago for infiltrating lobular carcinoma (Stage T2N2M0), with positive estrogenic receptors. Oncological controls showed pleural and bone progression in the last year, so hormonal therapy was indicated. She was admitted to the emergency department due to 72 hours of left lower-quadrant abdominal pain associated with constipation and nausea. On examination she presented tenderness and a palpable mass in the left lower quadrant. Blood tests showed an increased leukocyte count of 13.5x103/µL with neutrophilia, a CRP of 356mg/L and high lactate levels (4.5mmol/L). An abdominal computed tomography (CT) scan showed a left inguinal abscess (6x8x7cm) communicating with an inflammatory mass involving the sigmoid colon, as well as extensive bone metastases, not visualized in previous CTs. An emergency Hartmann's procedure was performed. The postoperative period was uneventful. The pathological report of the surgical specimen informed of infiltration in multiple diverticula by a carcinoma, with morphological pattern and immunohistochemistry compatible with a lobular breast carcinoma. The patient was derived to the Department of Oncology to continue follow-up and hormonal therapy.

Conclusions

Gastrointestinal breast metastases are uncommon, however, we should consider this diagnosis in patients with tumoral progression presenting with abdominal symptoms. Metastatic patients should receive medical treatment, reserving surgery for complications like obstruction or perforation, as in the case presented.

乳腺癌是当今女性中最常见的癌症类型。根据已发表的主要研究，乳腺癌最常见的转移部位是骨、肺、肝和脑。然而，它也很少转移到胃肠道。在不同亚型的乳腺癌中，胃肠道扩散与浸润性小叶癌有关。我们报告一例穿孔性急性憩室炎手术，病理检查提示小叶性乳腺癌结肠转移。病例报告:78岁女性，既往有高血压、糖尿病病史，14年前因浸润性小叶癌(T2N2M0期)行左乳切除术，雌激素受体阳性。肿瘤对照显示去年胸膜和骨骼进展，因此需要激素治疗。她因72小时左下腹疼痛伴便秘和恶心而入院急诊。检查时，她表现出压痛和左下腹可触及的肿块。血液检查显示白细胞计数增加13.5x103/µL，伴有嗜中性粒细胞增多，CRP为356mg/L，乳酸水平高(4.5mmol/L)。腹部计算机断层扫描(CT)显示左侧腹股沟脓肿(6x8x7cm)与炎性肿块(累及乙状结肠)相连，以及广泛的骨转移，在以前的CT中未见。紧急进行了哈特曼手术。术后顺利。手术标本的病理报告显示多发性憩室浸润癌，其形态和免疫组织化学与小叶性乳腺癌相一致。患者被转至肿瘤科继续随访及激素治疗。结论乳腺胃肠道转移并不常见，但当肿瘤进展伴有腹部症状时，应考虑此诊断。转移性患者应接受药物治疗，如本病例所示，保留手术治疗梗阻或穿孔等并发症。

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引用次数: 0

Dasatinib related pericardial effusion requiring pericardial drainage 达沙替尼相关性心包积液需要心包引流

New Horizons in Clinical Case Reports

Pub Date : 2017-08-01 DOI: 10.1016/j.nhccr.2017.06.179

Kyriacos Mouyis *, Sofia Metaxa, Constantinos Missouris

Introduction

Dasatinib is an oral Bcr-Abl and Src family tyrosine kinase inhibitor approved for use in patients with chronic myelogenous leukaemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukaemia (ALL). Its common side effects include myelosuppression, oedema, diarrhea and nausea. It has also been associated with the formation of pleural and pericardial effusions. As a result, Dasatinib is to be avoided in patients with pre-existing effusions or predisposition to respiratory or cardiovascular disease.

Case description

A fit 62-year-old pilot with no relevant medical history was diagnosed with CML in 2014, and commenced on Dasatinib therapy (100mg OD). A subsequent trans-thoracic echocardiogram (TTE) revealed normal ventricles and cardiac valves. There was however a mild to moderate global pericardial effusion, without haemodynamic compromise. This was regularly monitored with TTEs and remained stable until May 2016, where it measured 2.1cm posteriorly around the LV and 1.0 cm around the RV. Due restrictions imposed by the Civil Aviation Authority in the UK, the patient was referred for pericardial window procedure, prior to being considered fit for flying.

Conclusions

Dasatinib is known to cause pleural and pericardial effusions. This has been reported in patients without any predisposing factors.(1) The link with pericardial effusions has been proven with robust statistical analysis.(2) No specific mechanism has been proposed but an immune mediated reaction or off target inhibition of growth factors may be involved.(3) Management includes dose interruption or reduction, and/or treatment with steroids.(3) Our case report re-enforces that Dasatinib is an important cause of pericardial effusion and TTE is the modality of choice for follow-up. Pericardial window and drainage may be needed in patients where this prohibits them from undertaking employment.

Take-home message

Dasatinib related pericardial effusions are a documented side effect of therapy. One should be vigilant in monitoring patients on the drug as effusions may progress over time and require intervention. TTE is the monitoring modality of choice. As far as we are aware this is the first case report for surgical intervention in a patient with Dasatinib induced pericardial effusion.

达沙替尼是一种口服Bcr-Abl和Src家族酪氨酸激酶抑制剂，被批准用于慢性髓性白血病(CML)和费城染色体阳性急性淋巴细胞白血病(ALL)患者。常见的副作用包括骨髓抑制、水肿、腹泻和恶心。它也与胸膜和心包积液的形成有关。因此，有积液或呼吸系统或心血管疾病易感的患者应避免使用达沙替尼。病例描述:一名健康的62岁飞行员，无相关病史，于2014年被诊断为CML，并开始接受达沙替尼治疗(100mg OD)。随后的经胸超声心动图(TTE)显示心室和心脏瓣膜正常。然而，有轻度至中度的全心包积液，没有血流动力学的损害。在2016年5月之前，这一情况一直保持稳定，在左室周围后2.1厘米，右室周围1.0厘米。由于英国民航局的限制，在被认为适合飞行之前，患者被转介进行心包窗手术。结论达沙替尼可引起胸膜和心包积液。(1)与心包积液的联系已被强有力的统计分析证实。(2)没有提出具体的机制，但可能涉及免疫介导的反应或生长因子的脱靶抑制。(3)管理包括剂量中断或减少，(3)我们的病例报告再次强调，达沙替尼是心包积液的重要原因，TTE是随访的选择方式。如果病人不能工作，可能需要心包开窗和引流。与达沙替尼相关的心包积液是有记载的治疗副作用。由于积液可能随着时间的推移而恶化，需要进行干预，因此应警惕监测服用该药的患者。TTE是首选的监测方式。据我们所知，这是首例手术治疗达沙替尼诱发心包积液的病例报告。

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