Bubbles in the Pericardium

Purulent pericarditis is a rare but life-threatening illness. Often, it may be masked by the primary infectious etiology like pneumonia, endocarditis, or CNS infection, leading to a delay in diagnosis and treatment. Echocardiography is the modality of choice for estimating the presence and size of pericardial effusion and detecting presence of tamponade.

We present a case of a young man with acute respiratory illness in whom clinical exam, electrocardiography, and classic echocardiographic findings played a key role in diagnosis. An echo-dense effusion (rather than echo-free space) appearing like "bubbles" within the pericardial space was seen and a purulent nature of the fluid was strongly suspected. Prompt institution of antimicrobial therapy and timely pericardial drainage resulted in complete clinical recovery of the patient.

In this case, timely diagnosis and prompt treatment of effusion with pericardial drainage and antibiotics resulted in complete recovery from this otherwise devastating infection.