Idiopathic Pericardial Tamponade in the Absence of Predisposing Factors: A Diagnostic Conundrum and Therapeutic Approach
Published: 2024-05-24
Page: 36-41
Issue: 2024 - Volume 6 [Issue 1]
Badr Abdalani *
Department of Cardiology P37, Ibn Rochd University Hospital (CHU Ibn Rochd), Casablanca, Morocco.
Omar Moufid
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
Ibtissam Charkaoui
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
Abdellah Boucetta
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. GH. Benouna
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
A. Drighil
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
R. Habbal
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Pericardial effusion, while not uncommon, poses significant diagnostic and therapeutic challenges, particularly when presenting as tamponade, especially in young individuals without identifiable risk factors. We present a compelling case of a 19-year-old with acute dyspnea ultimately diagnosed with idiopathic pericardial tamponade. Despite a comprehensive evaluation ruling out infectious, neoplastic, and autoimmune etiologies, the underlying cause remained elusive. Urgent intervention via ultrasound-guided pericardiocentesis revealed hemorrhagic fluid, underscoring the critical role of timely management. Treatment with aspirin and colchicine resulted in symptom resolution, highlighting the efficacy of this therapeutic approach. Long-term follow-up demonstrated no recurrence, emphasizing the favorable prognosis associated with conservative management. This case underscores the importance of a systematic diagnostic approach and the need for further research to elucidate the pathophysiology and refine treatment strategies for this perplexing condition.
Keywords: Pericardial effusion, tamponade, idiopathic, non-steroid anti-inflammatory drugs, colchicine, pericardocentesis
How to Cite
Downloads
References
Adler Y, Charron P, Imazio M, et al. ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921-2964. DOI: 10.1093/eurheartj/ehv318
Risti AD, Imazio M, Adler Y, et al. Triage strategy for urgent management of cardiac tamponade: A position statement of the european society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2014;35(34):2279-2284. DOI: 10.1093/eurheartj/ehu217
Schwier NC, Cornelio CK, Epperson TM. Managing acute and recurrent idiopathic pericarditis. JAAPA. 2020;33(1):16-22. DOI:10.1097/01.JAA.0000615468.46936.6d
Blank N, Lorenz HM. Idiopathic pericarditis—an autoinflammatory disease? Curr Rheumatol Rep. 2019;21(5): 18. DOI: 10.1007/s11926-019-0820-2
Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA. 2015;314(14):1498. DOI: 10.1001/jama.2015.12763
Lazaros G, Vlachopoulos C, Lazarou E, Tsioufis K. New approaches to management of pericardial effusions. Curr Cardiol Rep. 2021;23(8):106. DOI: 10.1007/s11886-021-01539-7
Lilly LS. Treatment of acute and recurrent idiopathic pericarditis. Circulation. 2013; 127(16):1723-1726. DOI: 10.1161/CIRCULATIONAHA.111.066365
Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34 (16):1186-1197. DOI: 10.1093/eurheartj/ehs372
Imazio M, Lazaros G, Valenti A, et al. Outcomes of idiopathic chronic large pericardial effusion. Heart. 2019;105(6): 477-481. DOI: 10.1136/heartjnl-2018-313532
Eisenberg MJ, Dunn MM, Kanth N, Gamsu G, Schiller NB. Diagnostic value of chest radiography for pericardial effusion. J Am Coll Cardiol. 1993;22(2):588-593. DOI: 10.1016/0735-1097(93)90069-D
Pérez-Casares A, Cesar S, Brunet-Garcia L, Sanchez-de-Toledo J. Echocardiographic evaluation of pericardial effusion and cardiac tamponade. Front Pediatr. 2017;5:79. DOI: 10.3389/fped.2017.00079
Jung HO. Pericardial effusion and pericardiocentesis: Role of echocardiography. Korean Circ J. 2012;42 (11):725. DOI: 10.4070/kcj.2012.42.11.725
Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade? Am J Med. 1998;105(2):106-109. DOI: 10.1016/S0002-9343(98)00192-2
Kim SR, Kim EK, Cho J, et al. Effect of anti-inflammatory drugs on clinical outcomes in patients with malignant pericardial effusion. J Am Coll Cardiol. 2020;76(13):1551-1561. DOI: 10.1016/j.jacc.2020.08.003
Shah SR, Alweis R, Shah SA, et al. Effects of colchicine on pericardial diseases: A review of the literature and current evidence. J Community Hosp Intern Med Perspect. 2016;6(3):31957. DOI: 10.3402/jchimp.v6.31957