Large pleural effusions causing cardiac tamponade: a case report and review of the literature

Hemodynamically significant cardiac tamponade physiology is an uncommon complication of a large pleural effusion. Previous reports have shown that this physiology can be reversed with thoracentesis. We describe a case of a 69-year-old man with multiple cardiac risk factors presenting with decompensated congestive heart failure and unstable angina. A coronary stent was placed in the left anterior descending artery. Two days postprocedure, he became unresponsive and hemodynamically unstable. A chest x-ray (CXR) revealed bilateral large-sized pleural effusions with transthoracic echocardiography demonstrating a small pericardial effusion, large right pleural effusion, and evidence of cardiac tamponade. A right thoracentesis was performed, draining almost 1,000ml of fluid and resulting in a rapid improvement of his hemodynamic profile.