A 93-year-old woman was admitted to the emergency department with sudden increase in habitual dyspnea and edema of the lower limbs.
He reported hypertensive heart disease with dyspnea III/IV NYHA with two previous admissions; neonate of the left breast diagnosed 4 years ago with monotherapy and left phakectomy.
She was being treated with furosemide or furosemide; fixed-dose inhaled corticosteroids and tamoxi.
She was walking under Barthels disease with cognitive error alone for all basic activities of daily living (ADL) with an index of 100/100 for Barthels disease, and instrumental activities (Lawtons index 8/8).
At admission, secondary to dyspnea, her functional status was dependent for all BADL (IB 50, with sphincter control and eating alone, for the rest was dependent).
Examination at admission showed good orientation and hydration; increased jugular venous pressure up to the mandibular angle not collapsed with inspiration; mild crepitant in both right lung bases cardiac edema up to 93%, decreased cardiac saturation in the rest of the knee
Laboratory tests showed normal blood count and coagulation, with data of chronic renal failure (urea 79 mg/dl, creatinine 1.9 mg/dl) with malnutrition (proteins 5.03 g/dl), the rest of the normal biochemical tests (including
Chest radiography: cardiomegaly, elevated right hemidiaphragm and atelectasis on right basis.
Electrocardiogram showed sinus rhythm with right axis deviation.
Upon admission, a ventilation-perfusion scintigraphy was performed due to high clinical suspicion, which resulted in a low probability of pulmonary thromboembolism.
On the other hand, an echocardiogram was performed in the presence of sudden right overload, which determined an ejection fraction of 69%, with the presence of an extracardiac mass that collapsed the right atrium TC and a giant LOabdominal cyst detected.
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It was decided to treat the giant cyst by curative attitude in order to improve the symptomatology of dyspnea, and thus recover the previous functional level of the ADL.
The treatment consisted of drainage, guided by ultrasound, of the maximum possible volume, with subsequent introduction of 99% alcohol, to prevent as far as possible the subsequent recurrence of the cyst.
It was extracted near four liquids, no longer being able to cope with the cyst.
She presented as the only complication during the intervention pain requiring acute treatment with metamizole and tramadol according to intravenous titration.
Abdominal ultrasound and a control echocardiogram were performed at discharge, showing the persistence of the cyst with lower volume and less compression on the right atrium, with clear symptomatic improvement for dyspnea (II NYHA).
The patient was discharged home with community assistance and monitored by the Support Team for Children's Support (ESAD).
Control was performed with abdominal CT at 3 months with persistent cyst size and grade II dyspnea, requiring minimal supervision in the bathroom independently for the rest of ADL.
