SHM Converge Scientific Abstract ePoster Gallery-A Tale of Two Forces: Concurrent Pulmonary Embolism and Pleural Effusion in a Patient With Sle

Pdf Summary

This case report describes a 43-year-old woman with newly diagnosed systemic lupus erythematosus (SLE) who presented with right calf pain, dyspnea, hemoptysis, and pleuritic chest pain. Her evaluation showed sinus tachycardia with new right-axis deviation, a large circumferential pericardial effusion on transthoracic echocardiography, and an acute pulmonary embolism on CT pulmonary angiography. She also had signs of right heart strain, including a dilated right ventricle with severely reduced systolic function and tricuspid regurgitation.<br /><br />Management was challenging because the two major problems—pulmonary embolism and pericardial effusion—required opposite hemodynamic considerations. A heparin infusion was started, and right heart catheterization confirmed pulmonary hypertension. Diagnostic pericardiocentesis was performed, but the effusion was only partially drained to avoid worsening right ventricular dysfunction by suddenly removing the pressure balance created by the embolism. Pericardial fluid was non-bloody, allowing clinicians to proceed with ultrasound-assisted catheter-directed thrombolysis for the pulmonary embolism. The pericardial effusion was then drained gradually over several days with serial echocardiographic monitoring, but it reaccumulated. Because of persistent recurrence, the patient ultimately underwent video-assisted thoracoscopic pericardiectomy and was discharged one week later.<br /><br />The report emphasizes that although both pulmonary embolism and pericardial effusion are known complications of SLE, their coexistence is uncommon and creates difficult management decisions. It highlights the need to individualize treatment based on careful understanding of cardiopulmonary physiology, since therapy for one condition can worsen the other.

Asset Subtitle

Kajal Patel

Meta Tag

Author List Kajal Patel, Kevin Isaak

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Pericardial Effusion

Concept Pulmonary Embolism

Concept Echocardiography

Concept CT Pulmonary Angiography

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Kajal Patel

Track Adult

Keywords

systemic lupus erythematosus

pulmonary embolism

pericardial effusion

right heart strain

pericardiocentesis

pulmonary hypertension

catheter-directed thrombolysis

tricuspid regurgitation

thoracoscopic pericardiectomy

cardiopulmonary physiology

Systemic Lupus Erythematosus

Pericardial Effusion

Pulmonary Embolism

Echocardiography

CT Pulmonary Angiography