Chest computed tomography scan
The finding on echocardiography in this study was concerning for a pericardial cyst vs pericardial mass; thus, further imaging was necessary to further evaluate the structure. Although transesophageal echo might have improved the visualization of the structure, the best imaging modalities for evaluating the pericardium is computed tomography (CT) scan or magnetic resonance imaging (MRI).
A CT scan of the patient's chest revealed large and loculated inflammatory pericardial effusion adjacent to the right ventricle. Although there appeared to be some extrinsic compression of the right ventricle, there was no early diastolic collapse and the patient showed no signs of hemodynamic compromise. The patient was completely asymptomatic.
After a multidisciplinary discussion that included the patient, the decision was made not to pursue pericardiocentesis but, rather, to allow the patient to continue with immunosuppressive therapy and follow up the effusion within a relatively short period of time with cardiac MRI.
The patient was instructed to come to the emergency room at the onset of any new symptoms, including chest pain, shortness of breath, palpitations, near syncope, or syncope at which point a pericardiocentesis would have been considered. Fortunately, he did well on tumor necrosis factor inhibitors and steroid therapy. His joint effusions and pain completely resolved. Follow-up MRI showed an improved pericardial effusion.
This case illustrates an unusual presentation of a common cardiac finding in patients with rheumatoid arthritis. Interventions should be tailored to the patient's clinical symptoms and risk.
Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology. 2006;45(Suppl4):iv4-7.
Life with Rheumatic Disease
The Simple Tasks campaign aims to educate rheumatology patients about policy issues impacting their care and encourage patients to advocate for healthcare policies that promote safe, effective, affordable, and accessible rheumatology care.
If you’re wondering what it’s like to live with a rheumatic disease, we invite you to explore these rheumatoid arthritis case studies and other case studies focusing on what it’s like to live with rheumatic diseases.
Lauren Lee Johnson
Lauren was 31-years old when she was officially diagnosed with lupus after 10 years of misunderstood symptoms. Two years later, Lauren received her second diagnosis of fibromyalgia. As a thriving professional, wife and mother to a beautiful 11-year-old daughter, Lauren fights to manage her symptoms each day and embrace moments of joy amid the pain. See Lauren’s Case Study >
Richard went from running 100-mile races to periodically collapsing and not being able to stand in his own home. At 37 years old, Richard was diagnosed with systemic lupus by his local rheumatologist, who – in Richard’s book – “wears a cape. He’s truly my hero.” And not only is Richard thankful for his relationship with his rheumatologist, he is grateful for the accessibility to rheumatologists within his community – an issue that many people face who live in areas where there is a deficit in the field. See Richard’s Case Study >
On the surface, Glen Massie is a 48-year-old man who is happily married with two kids. He works as a transportation planner with the local Metropolitan Planning Organization, and his “free” time is spent giving back. In big ways. From his active membership in the Marine Corps League, to his participation in a local bluegrass group, to his involvement in fundraising efforts for the Vasculitis Foundation, Glen’s thumbprint on the community is hard to miss. And he also volunteers his time as a clown, making others laugh. See Glen’s Case Study >
Two weeks before her 16th birthday Tierra was diagnosed with systemic scleroderma – a disease of which she knew nothing. Tierra researched her diagnosis and was lucky to immediately connect with a rheumatologist, providing the opportunity to ask questions and learn. Several years later Tierra has a deeper understanding of her diagnosis, thanks in large part to the relationship she’s built with her rheumatologist, whom she calls a true partner. Tierra shares her story to offer support and help other patients find their voice. See Teirra’s Case Study >
As a young, successful, fashion and beauty correspondent, Christine Schwab was shocked to hear she had rheumatoid arthritis at the age of 43. Christine was shocked at the diagnosis because she had always believed ‘arthritis’ to only strike elderly people, a perception she would later work hard to change. And, through her struggles, Christine has found her window of opportunity by working with a rheumatologist and becoming a rheumatology advocate. See Christine’s Case Study >
At the age of eight, Katie Emmerson was diagnosed with polyarticular juvenile arthritis during surgery to remove a tumor from her wrist. By the age of 12, her arthritis left her in a wheelchair. Now, at 27, Katie sees everyday tasks as major battles and triumphs. And, Katie has found her window of opportunity by encouraging others with rheumatic diseases to see a rheumatologist early. See Katie’s Case Study >
Diagnosed with both rheumatoid arthritis and lupus at 50, Michael Taffe found the simple tasks of opening medicine bottles, holding a coffee mug, and working impossible. But, he also found his window of opportunity. See Michael’s Case Study >
Maya Rogers was a normal eight-year-old child until her family noticed subtle symptoms that led to a diagnosis of juvenile arthritis. Limited access to a rheumatologist and financial and insurance restrictions forced the entire Rogers family to make tough decisions for the health of Maya. With the help of a rheumatologist and Maya’s positive attitude, the family found their window of opportunity. See the Rogers family Case Study >
As an active, vibrant 18 year old, Shanelle Gabriel’s life was changed when a series of seemingly random symptoms led to a diagnosis of lupus. While lupus has robbed Shanelle of her ability to dance competitively, she has found her window of opportunity to through appropriate treatment by a rheumatologist and by using her disease to inspire new art in her life. See Shanelle’s Case Study >
Diagnosed with juvenile idiopathic arthritis at 10, Ashley Boynes-Shuck found the simple tasks of playing softball and brushing her teeth impossible. But, she also found her window of opportunity. See Ashley’s Case Study >
She was 15-months old when she was officially diagnosed with juvenile idiopathic arthritis. Despite her everyday struggles, Alexa has a glowing spirit and a positive outlook on life, with big hopes for the future. Alexa, by many definitions, is lucky because she was diagnosed early – within the window of opportunity. See Alexa’s Case Study >
He was an active 19-year-old when he was diagnosed with gout. Like many, before his diagnosis Seth had no idea what rheumatic disease was. But he found his window of opportunity. See Seth’s Case Study >
Leslie M. was 19-years old when she was diagnosed with rheumatoid arthritis and 26-years old when she was diagnosed with undifferentiated connective tissue disease (UCTD). Now 28-years old, Leslie seeks to educate other young women on the unexpected impact of rheumatic diseases. See Leslie’s Case Study >