PMC9553751_01
Admission ECG showing sinus tachycardia with right bundle branch block and right axis deviation.
CRIC2022-5440635.001.jpg
PMC9553751_01_CRIC2022-5440635.001.jpg
fig1
After central venous catheterization, CVP range was 25-30 cm H2O (Figure 1).
Admission transthoracic echocardiography showing circumferential pericardial effusion, reaching posteriorly 26 mm without compression of right atrium and ventricle. There is normal left ventricular wall thickness and contractility (LVEF > 70%). Severe right ventricular hypertrophy with flattened septum and severe PASP. There is a severe functional TR due to annulus dilatation and tethering of the tricuspid leaflets.
CRIC2022-5440635.002.jpg
PMC9553751_01_CRIC2022-5440635.002.jpg
fig2
The estimated pulmonary artery systolic pressure (PASP) was more than 115 mmHg while the left ventricle was underfilled but with a good systolic function (Figure 2).
Postpericardiocentesis follow-up transthoracic (a, b) and transesophageal (c, d) echocardiograms showing (1) normal left ventricular dimensions and systolic function, (2) dilated right-sided chambers with reduced RV function, (3) severe functional TR, and (4) no residual pericardial effusion.
CRIC2022-5440635.003.jpg
PMC9553751_01_CRIC2022-5440635.003.jpg
fig3
Emergency echocardiography revealed normal left ventricle while severely dilated right ventricle with systolic dysfunction and increased PASP more than 150 mmHg and minimal pericardial effusion (Figure 3).
Bilateral diffuse subarachnoid cisterns and intersulcal hyperdensity resembling subarachnoid hemorrhage with a left parieto-occipital cortical and subcortical hypodensity (a, b). Right frontal external ventricular drain with left parietal occipital cortical and subcortical hypodensity with loss of gray-white matter differentiation and focal hyperdensity representing infarction with hemorrhagic transformation (c). Increased cerebral edema with bilateral diffuse loss of gray-white matter differentiation of brain parenchyma (d).
CRIC2022-5440635.004.jpg
PMC9553751_01_CRIC2022-5440635.004.jpg
fig4
Withdrawal of support was done, and the patient was declared dead (Figure 4).