Massive left ventricular thrombosis in pericardial decompression syndrome

Area of Science:

• Cardiology
• Internal Medicine
• Oncology

Background:

• Pericardial decompression syndrome (PDS) is a rare but serious condition causing hemodynamic instability after pericardial fluid drainage.
• It is characterized by ventricular dilation and systolic dysfunction, often under-recognized and underreported.

Observation:

• A unique case of PDS with left ventricular (LV) systolic dysfunction and apical thrombosis is presented.
• This occurred in a 72-year-old male after surgical pericardial fluid removal, with concurrent undiagnosed lung cancer.

Findings:

• The patient experienced significant LV systolic dysfunction and a large apical thrombus post-pericardial fluid removal.
• Treatment with anticoagulation and anti-remodeling agents led to complete thrombus resolution and LV function recovery.

Implications:

• PDS, though uncommon, carries substantial morbidity and mortality risks.
• LV apical thrombosis can be a complication of PDS in hypercoagulable states, such as malignancy.
• Addressing the underlying condition, like lung cancer, is crucial for PDS management and recovery.