Chronic massive pericardial effusion: a case report and literature review

Abstract

Chronic massive pericardial effusion without cardiac tamponade is relatively rare. Nearly half of all patients with chronic large pericardial effusion are asymptomatic. We report a case of a 77-year-old man who presented with an asymptomatic chronic massive pericardial effusion, with no evidence of cardiac tamponade or pericardial constriction during a 10-year follow-up. The patient had a complex history of lymph node tuberculosis, hypertension, hypothyroidism, and polycythemia vera, as well as high-dose 31P radiation exposure 45 years ago. There was no evidence of tuberculosis infection, hypothyroidism, malignant tumor, severe heart failure, uremia, trauma, severe bacterial or fungal infection, chronic myeloid leukemia, or bone marrow fibrosis after admission. The patient underwent pericardiocentesis twice. The pericardial effusion comprised exudate fluid with a high proportion of monocytes. The patient refused indwelling catheter drainage or pericardiectomy. The likely final diagnosis was recurrent chronic large idiopathic pericardial effusion.

Pericardial effusion among children: Retrospective analysis of the etiology and short‐term outcome in a referral center in the south of Iran

“…10,11 The symptomatic cases present with different symptoms including shortness of breath or difficulty breathing (dyspnea), feeling of discomfort while breathing in the supine position (orthopnea), cough, mild fever, palpitations, and chest pain which is usually behind the sternum or on the left side of the chest. 10,11 Rapid accumulation of large amounts of fluid in the pericardial space leads to tamponade and its related symptoms. 12,13 In many cases, the cause is evident or can be suggested from the history and previously obtained diagnostic tests.…”

Tuberculous pericarditis-a silent and challenging disease: A case report

“…TP diagnosis is confirmed if one of the following criteria is present: Positive culture for the bacillus of Koch in pericardial fluid, positive direct examination for Koch bacillus, or value greater than 50 IU/L on the Adenosine deaminase (ADA) test[ 14 ]. Furthermore, the diagnosis can be confirmed if the pericardial biopsy shows the following findings: Positive culture for the Koch bacillus and granulomas with caseous necrosis, or presence of Langhans-type multinucleated giant cells, or presence of tubercle bacilli in the sample[ 15 ].…”

Hypothyroidism-Related Cardiac Tamponade

“…Hypothyroidism can cause various cardiac manifestations, such as bradycardia, atrial fibrillation, diastolic hypertension, varying degrees of atrioventricular (AV) block, prolonged QT interval leading to torsades de pointes, accelerated coronary artery disease, and pericardial effusion [7]. Clinically, hypothyroidism associated pericardial effusion can vary from being asymptomatic to presenting as cardiac tamponade, in which patients present with hemodynamic compromise [11]. Pericardial effusion can be classified based on onset (acute, subacute, and chronic), composition (transudative or exudative), and by its size, i.e., mild (<10 mm), moderate (10-20 mm), or large (>20 mm) [10].…”

“…Thus, it takes weeks to months before symptoms start to appear, making cardiac tamponade a rare presentation in hypothyroidism [10]. Literature suggests that about half of all patients with chronic large pericardial effusion are asymptomatic [11]. When present, the patients may present with symptoms such as dyspnea (61.1%), cough (25%), and chest pain (13.9%) in the setting of clinical symptoms of severe hypothyroidism, including lethargy, facial swelling, dry skin with non-pitting edema, delayed relaxation of deep tendon reflexes.…”