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Stuck pericardial pigtail catheter in purulent pericarditis: early surgery?
Akhilesh Gonuguntla1, Anila Vasireddy1, Aadithiyavikram Venkatesan1
1Kasturba Medical College, Manipal, India.
Abstract:
Pyopericardium is rare in the modern antibiotic era but is still infrequently seen in the setting of immunosuppression, recent thoracic surgery and sepsis. Although classically an extension of a thoracic gram-positive bacterial infection, gram-negative bacterial purulent pericarditis may be encountered in the setting of nosocomial infections. Emergent pericardial drainage allows for prompt definitive management and planning for further intervention. Early surgery should be the priority after a failed retrieval of the catheter. Appropriate surgical methods should be employed to minimize complications associated with stuck catheters. We report a case of pyopericardium secondary to a clinically silent lung abscess in an immunocompetent 49-year-old patient. This was treated by standard pericardial drainage via a pigtail catheter. Multiple failed attempts in removal warranted a surgical approach to remove the coiled catheter. The catheter was found to be coiled around the heart with presence of clots in the pericardium.
Insights
Pyopericardium, or pus in the pericardial sac, is rare but can occur with infections. This case highlights a silent lung abscess causing pyopericardium, requiring surgical intervention due to catheter complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Thoracic Surgery
Background:
- Pyopericardium is a rare condition, often associated with immunosuppression, thoracic surgery, or sepsis.
- While typically stemming from gram-positive bacterial infections, gram-negative bacteria can cause purulent pericarditis, especially in nosocomial infections.
Observation:
- A 49-year-old immunocompetent patient presented with pyopericardium secondary to a clinically silent lung abscess.
- Initial treatment involved pericardial drainage using a pigtail catheter.
Findings:
- Multiple attempts to retrieve the pigtail catheter failed, necessitating surgical intervention.
- During surgery, the catheter was found coiled around the heart, with associated clot formation within the pericardium.
Implications:
- This case underscores the importance of prompt pericardial drainage for definitive management.
- Early surgical consideration is crucial for stuck catheters to minimize complications.
- The findings emphasize that pyopericardium can arise from unexpected sources like silent lung abscesses.
