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Spontaneous Echo Contrast in Purulent Pericardial Effusion due to Non-Gas-Forming Organisms
Ming-Jui Hung1, Chao-Hung Wang, Dah-Wel Liu
1Cardiology Section, Department of Internal Medicine, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung, Taiwan.
Abstract:
We present the case of a 55-year-old man who developed massive pericardial effusion with tamponade within a 5-day period. During transthoracic two-dimensional echocardiographic examination, spontaneous echo contrast was visualized in pericardial effusion. A diagnosis of polymicrobial pyopericarditis was made when urgent pericardiocentesis revealed a significantly foul odor and purulent fluid that grew a culture of aerobes. After surgical drainage and appropriate antimicrobial therapy, this patient's pyopericarditis resolved. It was suggested that spontaneous echo contrast in pericardial effusion could be induced by non-gas-forming pyogenic cells.
Insights
A 55-year-old man experienced rapid pericardial effusion and tamponade. Echocardiography revealed spontaneous echo contrast, leading to a diagnosis of polymicrobial pyopericarditis, which resolved with drainage and antibiotics.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Pericardial effusion can lead to cardiac tamponade, a life-threatening condition.
- Pyopericarditis, or infected pericardial effusion, requires prompt diagnosis and treatment.
- Spontaneous echo contrast in pericardial effusions is an uncommon finding.
Purpose of the Study:
- To report a case of massive pericardial effusion with tamponade.
- To highlight the echocardiographic finding of spontaneous echo contrast in pyopericarditis.
- To discuss the potential cause of spontaneous echo contrast in this context.
Main Methods:
- Transthoracic two-dimensional echocardiography for imaging the pericardial effusion.
- Urgent pericardiocentesis for fluid analysis and therapeutic drainage.
- Microbiological culture of pericardial fluid to identify causative organisms.
- Surgical drainage and antimicrobial therapy for treatment.
Main Results:
- A 55-year-old male presented with massive pericardial effusion and tamponade developing over 5 days.
- Echocardiography demonstrated spontaneous echo contrast within the pericardial effusion.
- Pericardiocentesis revealed purulent fluid with a foul odor, and cultures grew aerobes, confirming polymicrobial pyopericarditis.
- The patient recovered fully after surgical drainage and antibiotic treatment.
Conclusions:
- Spontaneous echo contrast in pericardial effusion may indicate non-gas-forming pyogenic cells.
- Prompt diagnosis and management of pyopericarditis are crucial for patient outcomes.
- Echocardiography can provide valuable diagnostic clues in complex pericardial effusions.