A Curious Case of Pericardiohydroptysis

Abstract

Rupture of the heart or pericardium is a rare clinical finding almost always associated with trauma to the chest. Non-traumatic pericardial rupture into the lung parenchyma and pleural space has not been reported in literature. Hence the progression or natural course is not known and the optimal management not defined. We report a case of a 65-year-old male patient with past medical history of hypertension and alcohol abuse who presented with complaints of fever, and sharp retrosternal chest pain and was found to have rupture of the pericardium into the right pleural space and lung parenchyma. The diagnosis was established with a computed tomography scan of the chest and a cardiac magnetic resonance imaging. Routine investigation and a surgical biopsy of the pericardium could not establish a cause for the pericardial rupture. He was treated as idiopathic pericarditis with improvement over time, and a repeat echocardiogram showed resolution of the pericardial effusion. More than a year after the initial presentation, the patient is stable with no complications. From the sequence of events, we presume that the productive cough which immediately preceded this diagnosis represented the coughing up of pericardial fluid (pericardiohydroptysis).