Pericardial Decompression Syndrome Complicated by Left Ventricular Thrombus and Systemic Embolization

Thromboembolic complications associated with acute pericardial decompression syndrome (PDS) is a rare complication after pericardiocentesis for cardiac tamponade.

A 61-year-old woman with metastatic breast cancer presented with neoplastic pericardial effusion and cardiac tamponade requiring urgent pericardiocentesis. Within 72 hours, she developed severe transient left ventricular dysfunction (left ventricular ejection fraction: 20%-25%), consistent with PDS. Left ventricular function improved rapidly; however, follow-up echocardiography revealed a highly mobile left ventricular thrombus. Despite initiation of low-molecular-weight heparin, she developed acute renal infarction consistent with systemic embolization.

PDS is uncommon and typically transient but may create a prothrombotic state due to severe reversible ventricular dysfunction. This case highlights a rare thromboembolic cascade in the setting of malignancy and transient myocardial stunning.

PDS may predispose to left ventricular thrombus and embolization. Early surveillance imaging should be considered in high-risk patients.