Pericardiocentesis: A Lifesaving Procedure
The normal pericardial sac contains 10–50 ml of pericardial fluid as a plasma ultrafiltrate that acts as a lubricant between the pericardial layers. Many pathological processes might cause inflammation with increase of production of pericardial fluid, such as pericarditis. A significant proportion of patients with pericardial effusion are asymptomatic, and pericardial effusion constitutes an incidental and unexpected finding on x-ray or echocardiogram performed for other reasons. The clinical presentation of pericardial effusion varies according to the speed of pericardial fluid accumulation. Classic symptoms include shortness of breath on exertion progressing to orthopnea, chest pain, and/or fullness. We present a case of a 61-year-old male, admitted in the emergency department referring tachypnea and shortness of breath which started 15 days from admission, with past medical history of adenocarcinoma of the right lung. Physical examination showed a heart rate of 120 bpm, respiratory rate of 22 bpm, blood pressure of 100/60 mmHg, heart sounds with S1 and S2 with normal intensity, tachycardia, regular rhythm, and no murmurs. There was no hepatojugular reflux. The chest x-ray at admission showed parenchymatous opacification close to the right hilum, a large pleural effusion, and enlarged cardiac area. During diagnostic work-up, a transthoracic echocardiogram was performed, which revealed the presence of pericardial effusion. Thus, pericardiocentesis was indicated, with introduction of a double-lumen catheter. The pericardial catheter was removed after 7 days. Pericardiocentesis is indicated for cardiac tamponade or for symptomatic moderate to large pericardial effusions not responsive to medical therapy and for suspicion of unknown bacterial or neoplastic etiology. Pericardiocentesis alone may be necessary for the resolution of large effusions, but recurrence is common, and pericardiectomy or less invasive options should be considered whenever fluid re-accumulates and becomes loculated or biopsy material is required. The prognosis of pericardial effusion is essentially related to the etiology.
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