PMC9649300_01
Upright AP CXR obtained on admission shows markedly enlarged cardiac silhouette, mild pulmonary vascular congestion, and bibasilar subsegmental atelectasis.
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C-reactive protein of 11 mg/L (reference range < mg/L), and erythrocyte sedimentation rate of 110 mm/hr (reference range < 30 mm/hr). Chest X-ray showed a markedly enlarged cardiac silhouette with mild pulmonary vascular congestion (Figure 1).
Initial transthoracic echocardiogram obtained on admission shows a large circumferential pericardial effusion measuring 2.24 cm (red line). Cardiac tamponade is present, evinced by early right ventricular diastolic collapse, significant respirophasic variation of mitral inflow and IVC dilation with decreased respiratory variation consistent with elevated right atrial pressure.
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There was some echocardiographic evidence for tamponade including early right ventricular diastolic collapse, respirophasic variation of mitral inflow and dilatation of the IVC with decreased respiratory variation consistent with elevated right atrial pressure (Figure 2).
Coronal view of chest CT with angiography obtained due to concern for aortic dissection shows large pericardial effusion (red line) without aortic dissection, pericardial or pleural thickening, or pericardial or pleural masses. Bilateral axillary lymph nodes with normal reniform morphology were present and were thought to be reactive in the setting of large pericardial effusion.
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Additionally, there was no pericardial or pleural thickening, or pericardial or pleural masses seen on CT (Figures 3-5) or cardiac MRI (Figure 6).
Chest CT with angiography: axial view at midthoracic level shows large pericardial effusion (red line) without pericardial or pleural thickening, or pericardial or pleural masses.
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Additionally, there was no pericardial or pleural thickening, or pericardial or pleural masses seen on CT (Figures 3-5) or cardiac MRI (Figure 6).
Chest CT with angiography: sagittal view shows large pericardial effusion (red line) without pericardial or pleural thickening or pericardial or pleural masses.
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Additionally, there was no pericardial or pleural thickening, or pericardial or pleural masses seen on CT (Figures 3-5) or cardiac MRI (Figure 6).
Cardiac MRI 10 days after initial presentation. Axial image captured in mid-diastole shows moderate pericardial effusion (red line) without pericardial or pleural masses.
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Additionally, there was no pericardial or pleural thickening, or pericardial or pleural masses seen on CT (Figures 3-5) or cardiac MRI (Figure 6).
Transthoracic Echocardiogram 4 weeks after initial presentation, showing trace circumferential pericardial effusion. The maximum diastolic dimension of the pericardial effusion seen is 7 mm posteriorly. There are no echocardiographic findings for cardiac tamponade. TEE at a 2-monthfollow-up showed no significant changes.
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Follow-up TTE four weeks after initial presentation showed stabilization of a small pericardial effusion (Figure 7).