Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

Abstract

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

Pyopericardium presenting as pericardial tamponade in a patient with common variable immunodeficiency disorder

“…Pyopericardium, or purulent pericarditis, is rare and rapidly fatal if left untreated. In treated patients, it has a mortality rate of up to 40%, related to cardiac tamponade and constriction 8–11 13–17. Pyopericardium can be caused by contiguous dissemination from pneumonia or empyema, by haematogenous spread, during cardiac or thoracic surgery or trauma 11 13 14.…”

“…Early clinical diagnosis is crucial for timely management and improved outcomes but is often elusive and obscured by the severity of the initial focus of infection, sepsis or mimics such as acute coronary syndrome 9 13 14 16 17. Diagnosis is frequently delayed until significant cardiac tamponade develops, which can result in a poor outcome even with pericardiocentesis 13–15…”

“…Initial laboratory tests demonstrated haemoglobin of 106 g/L,8–12 white cell count 41.1×10ˆ9/L (4–10), with 38.8×10ˆ9/L neutrophils (16.4–32.8), platelets 395×10ˆ9/L (150–400), international normalised ratio 1.7, alanine aminotransferase 64 IU/L (<40) and lactate dehydrogenase 449 U/L (135–225). Cardiac enzymes remained normal.…”