A difficult-to-diagnose pericardial fistula

Area of Science:

• Cardiology
• Gastroenterology
• Diagnostic Imaging

Background:

• Pericardial effusion is a known complication, but pericardial fistula is exceptionally rare.
• Gastric cancer can present with various complications, including cardiac involvement.

Observation:

• A 71-year-old female with remnant gastric cancer presented with worsening dyspnea and pericardial effusion.
• Initial imaging and pericardiocentesis were inconclusive, with no cancer cells found in the drainage.
• A distinct color change of the pericardial fluid (turbid to golden yellow to green) was observed.

Findings:

• Despite extensive investigations, including repeated imaging and laboratory tests, the cause of the effusion remained elusive.
• Standard diagnostic imaging failed to confirm a pericardial fistula.
• A methylene blue test ultimately confirmed the presence of a pericardial fistula.

Implications:

• The study highlights the diagnostic challenges of rare pericardial fistulas, especially when conventional imaging is negative.
• A change in pericardial effusion color should raise suspicion for a pericardial fistula.
• Alternative diagnostic methods, like the methylene blue test, are crucial when imaging is inconclusive.