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A 76-year-old woman with anaemia and cardiomegaly


A 76-year-old woman was referred to our hospital due to further evaluation of anaemia. During the past 3 years, she had been treated for multiple spinal compression fractures with vertebroplasty. Her blood pressure was 90/50 mm Hg, heart rate 75 beats/min, body temperature 37.7°C and respiratory rate 20/min at admission.

On blood sampling, her haemoglobin level was 5.2 g/dL and white cell count and platelet count 3.7 and 22×103/ µL, respectively. She was diagnosed with multiple myeloma after serial diagnostic workups. Because her chest radiography showed cardiomegaly and left-sided pleural effusion with small atelectasis, transthoracic echocardiography and contrast enhanced chest CT were performed (figure 1, see online supplementary video).

Supplementary Material

Supplementary video

Figure 1

(A) Apical four-chamber view by transthoracic echocardiography and (B) the coronal image of contrast-enhanced  chest CT.

Question Which of the following is the most likely diagnosis of the cystic lesion?

  1. Ascites

  2. Pericardial cyst

  3. Pericardial effusion

  4. Bronchogenic cyst

  5. Pleural effusion


  • Ascites
  • diaphragmatic hernia
  • echo-free spaces around the heart

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