Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone

Abstract

Systemic lupus erythematosus (SLE) is often complicated by pericarditis with effusion, which generally responds well to glucocorticoid. We report herein a Japanese patient with SLE who showed a sign of cardiac tamponade and severe chest and back pain because of massive intractable pericardial effusion. Pulse glucocorticoid and pulse cyclophosphamide gained marginal effects. Pericardial effusion accumulated again soon after ultrasound-guided pericardiocentesis and drainage. Pericardial fenestration performed surgically as a last resort, for draining pericardial fluid into the pleural space, was very effective, and only a much smaller amount of fluid was observed in the space thereafter in comparison with the volume before the surgery. Pathological examination of the retrieved pericardium unfolded intense hyperplasia of small vessels and capillaries. Levels of IL-6 and TNF-alpha in pericardial effusion were extremely higher than those in serum. Pericardial effusion with extensive capillary hyperplasia in SLE would be resistant to medical treatment and require surgical fenestration.

Pericardiopleural window creation with a small anterior thoracotomy

“…[1] Recurrences are more common in pericardial effusions, and malignancies and idiopathic reasons may cause to persistent fluid accumulation in the pericardial sac. [1] Repeated pericardiocentesis may be required and the need for more efficient and long-lasting solutions may arise. The implementation of surgical procedures which can more efficiently relieve symptoms and prevent heart failure and mortality risk due to cardiac tamponade is required.…”

“…The large volume of fluids prevents to the cardiac functions and leads to fatal outcomes. [1] A rapid accumulation of low amount of fluid causes cardiac tamponade, as well. [1] Recurrences are more common in pericardial effusions, and malignancies and idiopathic reasons may cause to persistent fluid accumulation in the pericardial sac.…”

“…[1] A rapid accumulation of low amount of fluid causes cardiac tamponade, as well. [1] Recurrences are more common in pericardial effusions, and malignancies and idiopathic reasons may cause to persistent fluid accumulation in the pericardial sac. [1] Repeated pericardiocentesis may be required and the need for more efficient and long-lasting solutions may arise.…”

“…Pericardial effusion may result from the several diseases, and infections, toxic materials, and malignancy are the most common causes. [1] The fluid accumulation in the pericardial sac induces the varying degree important symptoms. The large volume of fluids prevents to the cardiac functions and leads to fatal outcomes.…”

“…Pericardial fenestration is a surgical procedure that can sometimes be implemented as the last resort. [1] Chronic pericardial effusions resistant to medical therapy can effectively be treated by a creating of pericardiopleural window. During the procedure, effective drainage and taken of biopsy specimens can be performed as both diagnostic and therapeutic targets.…”