Figure 23.

Cholesterol pericardial heart disease in a 34-year-old woman with hypothyroidism. She was short and stocky and had enlarged earlobes, bilateral hypoplastic fourth toes, receding hairline, small tongue, and no menstruation. She had orthopnea, pedal edema, and hypoactive deep tendon reflexes. Chest radiograph showed a globular-shaped cardiac silhouette and clear lung fields, and angiogram showed an 18-mm-thick pericardial effusion. Despite diuresis, the pedal edema persisted. Pleuritic-type anterior chest pain appeared, and a 15-mm paradoxic pulse pressure was measured. Pericardiocentesis produced 500 mL of cloudy golden-colored fluid. The polyethylene catheter was left in place and over the next 5 days, 2 L of fluid was removed. Fluid cholesterol was 165 mg/dL; serum cholesterol was 355 mg/dL. The patient improved after pericardiocentesis but became anuric following aortography and died. (a) Exterior surface of the heart and pericardium showing thickening of the parietal pericardium and focal deposits of cholesterol (yellow) over the right ventricle. (b) View of thickened parietal pericardium over the right atrial appendage and an epicardial cholesterol deposit. (c) Foam cells in the cholesterol deposit shown in (b). (d) Cholesterol granuloma in the pericardium showing cholesterol clefts and a foreign body reaction. (e) Frozen section of epicardial deposits stained for lipid. The foam cells stain strongly for lipid. Hematoxylin-eosin stain, ⋇400 (c), ⋇50 (d); oil-red O stain, ⋇400 (e).