Large pericardial effusion due to peritoneopericardial fistula

A 50 years old male with previous history of dilated cardiomyopathy was admitted to cardio-intensive unit with dyspnea, cough, ascites and lower limb edema ascending to the inguinal region. 2D-Ecocardiogram revealed large pericardial effusion, without signs of diastolic restriction. The patient underwent pericardial drainage, which rapidly recollected in the following day. Abdominal ultrasound showed fibrotic and reduced size liver and subsequent radionuclide scan demonstrated direct communication between peritoneal and pericardial spaces. With the resolution of ascites, pericardial effusion did not recur. Embryologic explanation of this rare condition is still elusive, but incomplete closure of diaphragmatic muscle and thoracic-abdominal communication may represent the model of this anatomic functional anomaly.