PMC7876917_01
CT scan showing important hepatomegaly and perihepatic fluid (A) and abundant pericardial effusion of about 30 mm thickness (B).
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Considering the worsening of the clinical picture, in the suspicion of a perforation, a CT scan of abdomen was performed in urgency; it confirmed the previous reports, demonstrating hepatomegaly, gallbladder wall thickness with pericholecystic and perihepatic fluid; moreover it showed abundant pericardial effusion (30 mm thickness) and thin right pleural effusion at the lung bases included in the scan (Fig. 1).
Echocardiogram showed a circumferential pericardial effusion with initial collapse of the right ventricular free wall.
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In view of surgery indicated for acute abdomen for cholecystitis, an echocardiogram was performed, which confirmed a circumferential pericardial effusion (it appears as an echo-free space between the two layers of the pericardium) with initial collapse of the right ventricular free wall (Fig. 2).