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Non-tamponade Indications for Pericardial Drainage: A Case Report of Acute Streptococcus pneumoniae Purulent
Toyin Ingram1, Aarti Narayan2, Noah Ene1
1Internal Medicine, Cape Fear Valley Health, Fayetteville, USA.
Insights
Pericardial drainage effectively treated acute bacterial pericarditis with fibrinous effusion in an immunocompetent male. This procedure was beneficial even without cardiac tamponade physiology.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Pericardial drainage, including pericardiocentesis and pericardial window, is crucial for managing pericardial effusions.
- These procedures are typically indicated for cardiac tamponade, relieving extrinsic compression on heart chambers and improving stroke volume.
- Indications for elective drainage encompass effusions from trauma, myocardial infarction, malignancy, pericarditis, and metabolic derangements.
Observation:
- A case report details a 66-year-old immunocompetent male with acute bacterial pericarditis.
- The patient presented with a fibrinous pericardial effusion.
- Notably, echocardiography did not reveal cardiac tamponade physiology.
Findings:
- Pericardial drainage was performed in this patient.
- The procedure proved beneficial in managing the fibrinous pericardial effusion.
- This suggests drainage can be effective even in the absence of overt tamponade.
Implications:
- This case highlights the potential utility of pericardial drainage in specific non-tamponade pericardial effusion scenarios.
- It expands the understanding of when pericardial effusion management might be considered.
- Further research could explore the role of drainage in similar presentations of bacterial pericarditis.
Abstract:
Pericardial drainage is a procedure completed to evacuate fluid from the pericardial space. This can be completed by pericardiocentesis or pericardial window. These procedures are most often done in the setting of cardiac tamponade, typically to correct low blood pressure due to low stroke volume from extrinsic compression of the heart chambers by the pericardial fluid. Elective pericardiocentesis can be done in cases where fluid accumulation is secondary to pathological processes, including hemopericardium secondary to complications of trauma to the chest, toxins, myocardial infarction, cardiac surgery, serosanguinous pericardial effusion due to malignancy, right heart failure, acute pericarditis, chemotherapeutic agents, metabolic derangements like uremia, and autoimmune disorders. Here, we report a case of a 66-year-old immunocompetent male with acute bacterial pericarditis resulting in fibrinous pericardial effusion without echocardiographic cardiac tamponade physiology in whom pericardial drainage proved beneficial.
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