PMC9637036_01
CT chest on hospital day 1 (a) and hospital day 7 (b). The pericardial effusion had expanded from a largest diameter of 1.5 cm (a) to 2.0 cm (b) along with increase in left pleural effusion.
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Computed tomography angiography (CTA) showed chronic fibrotic lung disease, new small pericardial effusion of 1.5 cm in its largest diameter, but no pulmonary embolism (Figure 1). A repeat CT scan showed that the pericardial effusion enlarged from 1.5 cm to 2 cm in its greatest width (Figure 1).
EKG on hospital day 7 with enlarging pericardial effusion. Normal sinus rhythm with new 2 mm ST elevations in leads I and II, 1 mm elevation in aVL, submillimeter elevations in V5-V6, and 1 mm ST depression in aVR and V1.
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An EKG at the time showed normal sinus rhythm with new 2 mm ST elevations in leads I and II, 1 mm elevation in aVL, submillimeter elevations in V5-V6, and 1 mm ST depression in aVR (Figure 2).
Parasternal long (a), apical 4-chamber view (b), and subxiphoid view (c) via echocardiography of expanding pericardial effusion on hospital day 7. No right atrial or right ventricular collapse or respiration variation in mitral or tricuspid inflow was seen. The inferior vena cava (IVC) was enlarged without collapse.
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On hospital day 7, an expanding pericardial effusion was seen on a limited TTE measuring 2.5 cm posteriorly in subcostal view with enlarged IVC but no evidence of tamponade without findings of atrial collapse, ventricular collapse, IVC collapse, or respiratory variation in mitral or tricuspid inflow (Figure 3).
Pericardiocentesis with immediate removal of 350 cc cloudy, tan-brown, sanguinous fluid.
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On day 8, he was transferred to the cardiac critical care unit for therapeutic pericardiocentesis; 350 mL of tan-brown cloudy thin fluid was drained under pressure, and a pericardial drain was left in place (Figure 4).