PMC9800266_01
Photograph of the patient's left arm taken 2 weeks prior to her emergency admission showing a vesicular rash in the T1 and T2 dermatomal distributions.
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Two weeks prior to her presentation, she had developed a painful vesicular rash following a T1 dermatomal distribution on the left (Figure 1) and completed a course of acyclovir.
Photomontage of representative images from radiologic studies displaying the patient's anteroposterior chest X-ray at the time of admission (A), echocardiographic subxiphoid view of the heart demonstrating the pericardial effusion and right ventricular collapse (B) (supplementary file), echocardiographic sagittal view of the inferior vena cava (IVC) demonstrating a non-collapsed IVC in mid inspiration (C), and an axial slice of the patient's computed tomography showing a large pericardial effusion.
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A chest radiograph revealed a cardio-thoracic ratio of 0.60 with clear lung fields (Figure 2A). An urgent computed tomography scan of the chest abdomen and pelvis revealed a large pericardial effusion, mild periportal oedema, and the absence of overt mass lesions, suspicious lymph nodes, or infection (Figure 2D). The clinical diagnosis of cardiac tamponade was supported by right ventricular collapse during diastole (Figure 2B) and an inferior vena cava that did not collapse on inspiration (Figure 2C).
Electrocardiogram taken at the time of the patient's emergency admission displaying subtle widespread ST elevation and PR depression most notable in lead II.
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An electrocardiogram showed sinus tachycardia, Q waves (V1-3) and widespread ST-segment elevation, and PR interval depression most notable in Lead II (Figure 3).
Follow-up electrocardiogram taken 3 months after our patient's discharge from hospital showing complete resolution of ST and PR segment changes.
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The follow-up of transthoracic echocardiogram at 2 weeks showed trace amounts of pericardial fluid and the ST and PR segment changes on the electrocardiogram had resolved (Figure 4).