Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

Abstract

Introduction Pericardial effusion (PE) related to COVID-19 has rarely been observed, with most reported cases being non-hemorrhagic. This study aims to present a rare case of post-COVID-19 hemorrhagic PE. Case report A 44-year-old male presented with shortness of breath upon exertion, palpitation, and left-sided chest tightness. He was a recently recovered from COVID-19. He was conscious, oriented, tachypneic, and tachycardic. Chest examination revealed a mixture of fine and coarse crackles along with muffled heart sounds. He had elevated D-dimer, C-reactive protein, prothrombin time, and aPTT. Computed tomography pulmonary angiogram showed acute pulmonary thromboembolism involving the posterior segmental lobar branch of the left lower lobe with concomitant pulmonary infarction. Echocardiography showed severe PE without diastolic collapse. Pericardial drainage was performed and by the 2nd day, there was no more effusion. On the 7th day, the patient developed severe complications which led to cardiac arrest. Discussion PE is the buildup of fluid in the pericardium. It has been rarely observed in relation to COVID-19, both during and after the viral infection. If PE is suspected, Echocardiography can be used to confirm its diagnosis. There is no standard management for these cases and only non-hemorrhagic patients with mild to moderate effusion can be treated using conservative measures. Conclusion Hemorrhagic PE can be a rare but possible post-COVID-19 sequel, and Echo can be used to confirm its diagnosis. Drainage is necessary to resolve the effusion.

Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

“…Providing that previously only Coxsackie virus infection was associated with hemorrhagic pericardial effusion, according to our case series, SARS-CoV-2 infection may also be a potential causal factor [ 21 ]. Similar findings were also reported in other published case reports [ 3 , 22 ].…”