Pericardial Decompression Syndrome after Drainage of Malignant Pericardial Effusion: A Case Report

Pericardial decompression syndrome (PDS) is an uncommon but potentially fatal complication that can follow technically successful drainage of a hemodynamically significant pericardial effusion. A 61-year-old woman with stage IVB lung adenocarcinoma presented with progressive dyspnea and edema. Computed tomography and transthoracic echocardiography demonstrated a large pericardial effusion with right ventricular diastolic collapse and preserved left ventricular ejection fraction (LVEF) of 65% to 70%. Emergent echo-guided pericardiocentesis removed 360 to 380 mL of serosanguineous fluid, followed by catheter drainage totaling approximately 1.51 L. The next morning, echocardiography showed new severe biventricular systolic dysfunction with basal sparing and only trivial residual effusion. High-sensitivity troponin remained 10 ng/L or less without a meaningful rise. The clinical course was managed supportively with close hemodynamic and echocardiographic surveillance, cautious diuresis, and low-dose guideline-directed therapy as tolerated. LVEF improved from a nadir of 15% to 20% to 50% to 55% at follow-up, with resolution of the wall-motion abnormality and no recurrent effusion. The temporal association with large-volume drainage, absence of recurrent pericardial constraint, low troponin, and reversible dysfunction supported PDS. New heart failure after malignant pericardial effusion drainage should prompt urgent evaluation for PDS.