PMC8598365_01
Electrocardiogram at presentation showing a sinus rhythm with a heart rate around 90 bpm and diffuse low voltage in both precordial and limb leads.
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A diffuse low voltage electrocardiogram (EKG) (Figure 1) raised a suspicion for pericardial effusion, which was confirmed on initial enhanced computed tomography (CT) of the abdomen and pelvis, showing large pericardial effusion and peritoneal fluid collection (Figure 2).
CT of the abdomen and pelvis with IV contrast on day 1. Mild bilateral basilar foci of atelectasis. Large pericardial effusion (yellow arrows in (b) and (c)). Large amounts of ascitic fluid (red arrows in (a)-(c)). Mild stranding of the peritoneum anteriorly.
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A diffuse low voltage electrocardiogram (EKG) (Figure 1) raised a suspicion for pericardial effusion, which was confirmed on initial enhanced computed tomography (CT) of the abdomen and pelvis, showing large pericardial effusion and peritoneal fluid collection (Figure 2).
Transthoracic echocardiogram on day 0. Very large pericardial effusion with a swinging heart (red arrows in (a) and (b)), RV diastolic collapse, and marked mitral inflow respiratory variation (red arrows in (c)) consistent with significant tamponade. (a) Apical 4-chamber view; (b) parasternal long-axis view; (c) apical 4-chamber view showing the position of the Doppler pulse wave vector to obtain the mitral inflow waveform; (d) mitral inflow waveform.
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An urgent transthoracic echocardiogram (TTE) confirmed the very large pericardial effusion with a swinging heart, right ventricular collapse, and marked mitral inflow respiratory variation (Figure 3), for which the patient was taken for an emergent pericardial window with removal of 1.5 liters of serous fluid and pericardial drain placement.
Transthoracic echocardiogram on day 1. The left ventricle has normal size. There is diffuse mild hypokinesis, LVEF is 45-50%. The right ventricular free wall appears thickened and echogenic. There is a small pericardial effusion. (a) Apical 4-chamber view and (b) parasternal long-axis view.
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A follow-up TTE (Figure 4) demonstrated a small pericardial effusion, a thickened and echogenic right ventricular (RV) free wall, and diffuse mild hypokinesis of the left ventricle (LV) with an Ejection Fraction (EF) of 45-50%.
Transthoracic echocardiogram 4 weeks since admission. The left ventricle has normal size. LVEF is 55-60%. LV strain is -19%. The right ventricle free wall is thick, and mitral valve leaflets are thickened. Small-to-moderate circumferential pericardial effusion. There is no evidence of tamponade. (a) Apical 4-chamber view and (b) parasternal long-axis view.
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Follow-up transthoracic echocardiogram 4 weeks later showed improved LV and RV systolic function with improved LVEF with mild pericardial effusion and no evidence of pericardial effusion (Figure 5).