Left ventricular inflow obstruction and shock due to herniated peritoneal sac filled with ascites

摘要

A 75-year-old woman with a history of Type 2 diabetes, hypertension,cerebrovascular accident, hiatal hernia, and recently diagnosedperitoneal mesothelioma with ascites was referred to our departmentfor transthoracic echocardiography under suspicion of cardiactamponade. During the preceding few weeks, the patient experiencedshortness of breath and abdominal distension. Physical examinationrevealed a critically ill patient with features of shock includingtachypnoea, tachycardia (117 b.p.m.), low blood pressure(90/65 mmHg), and cold extremities. Heart sounds were normal.The electrocardiogram showed a sinus tachycardia of 110/min withlow voltages, without signs of electrical alternans. Transthoracicechocardiography demonstrated almost complete compression ofthe left atrium by a large and dense extracardiac mass (white arrow,Figure 1 and Video 1) leading to significant inflow obstruction over themitral valve with 33% drop in mitral E-wave velocity on inspiration.Computed tomography revealed a large hiatal hernia with herniationof the stomach (blue arrow) and peritoneal sac filled with ascites (yellowarrow), resulting in compression of the left atrium (black arrow).