The Vanishing Act: Post-pericardiocentesis Pericardial-pleural Fistula in Secondary Hyperparathyroidism

Pericardial-pleural fistula (PPF) may complicate between 0.8-6% of echocardiography-guided pericardiocentesis procedures, but reports are sporadic. A 22-year-old male presented to the general medical ward with underlying end-stage renal disease complicated by secondary hyperparathyroidism with worsening left pleuritic chest pain and shortness of breath for one week. Ultrasonographic investigations revealed global pericardial effusion, with no pleural effusion initially. After echocardiographic-guided pericardiocentesis via the apical approach, the patient developed respiratory distress. Follow-up ultrasound revealed a new pleural effusion with resolved pericardial effusion. The patient recovered with drainage of the pleural effusion. Bacterial and tuberculous cultures were negative, and fluid cytology was benign. Hyperparathyroidism may have contributed to the increased risk of PPF due to pericardial calcification. Clinicians should be aware of the potential risk of PPF after pericardiocentesis in patients with hyperparathyroidism.