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The following electronic only articles are published in conjunction with this issue of Heart.

Paracardial lipodystrophy versus pericardial effusion in HIV positive patients

T Neumann, J Barkhausen, T Bartel

Objective: To present an epicardial manifestation of the lipodystrophy syndrome, a side effect of antiretroviral treatment in HIV positive patients, which illustrates the important danger of false diagnosis.

Patient: A 52 year old man with HIV (stage C3), diagnosed 10 years previously, was being treated with a combination of nelfinavir, nevirapine, and stavudine. Echocardiographic examination showed a low echogenic pericardial space that had increased tremendously from 4 mm to 18 mm over a 10 month period. The diagnosis of paracardial adipose tissue was verified by magnetic resonance tomography. Doppler echocardiographic parameters were not significantly altered (ratio of early to late ventricular filling 0.88 v 0.73, Tei index 0.30 v 0.36).

Conclusion: Even a pericardial manifestation of lipodystrophy causes negligible functional impairment. Misinterpretation of the lipodystrophy as a pericardial effusion and a subsequent puncture can have serious complications. Hence, it is strongly suggested that further differential diagnosis be used for HIV positive patients with an echocardiographic suspicion of pericardial effusion. Differential diagnosis by magnetic resonance tomography is possible.

(Heart 2002;87:e4)

Churg-Strauss syndrome with critical endomyocardial fibrosis: 10 year survival after combined surgical and medical management

C R McGavin, A J Marshall, C T Lewis

A case is presented of the Churg-Strauss syndrome with hypereosinophilia and severe cardiac involvement, namely biventricular endomyocardial fibrosis and gross encroachment of the right ventricular cavity. The clinical picture was similar to Loeffler's syndrome and the idiopathic hypereosinophilic syndrome. Combined aggressive surgical and medical management led to full recovery and survival at 10 years. The good long term outcome is attributed to strict control of peripheral eosinophil count by oral corticosteroids. This case illustrates the damaging effects of hypereosinophilia on the heart.

(Heart 2002;87:e5)

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