Pericardial hematoma mimicking pericardial abscess

A 26-year-old man, with human immunodeficiency virus infection, on hemodialysis, was hospitalized due to infective endocarditis. A mechanical prosthetic mitral valve was implanted. During postoperative period, he maintained signs suggestive of infection. The transthoracic echocardiograms (TTE) revealed a pericardial effusion. One week later was visible a circumscribed collection compatible with a pericardial abscess. He was refused for cardiac surgery; however, inflammatory parameters elevation persisted. The TTE showed a periprosthetic mitral leak, and cardiac surgery was performed. The pericardial drainage revealed a hematoma. This case highlights the difficulty on echocardiographic differential diagnosis between a pericardial hematoma and pericardial abscess in clinical practice.