SHM Converge Scientific Abstract ePoster Gallery-Idiopathic Pericarditis Leading to Massive Hemorrhagic Pericardial Effusion

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This case describes a 69-year-old woman with stage IV breast cancer who presented with abdominal pain, dyspnea on exertion, fatigue, intermittent chest pain, tachycardia, hypotension, and Beck’s triad, suggesting cardiac tamponade. Imaging showed a large circumferential pericardial effusion with right atrial collapse and dilated venous structures.  <br /><br />Pericardial drainage was performed, yielding more than 900 mL of hemorrhagic fluid. Fluid analysis showed an exudative sample rich in red blood cells, but no malignant cells were found. Her effusion improved after drainage, and the pericardial drain was removed. She was discharged on NSAIDs and colchicine. The final diagnosis was idiopathic pericarditis causing a massive hemorrhagic pericardial effusion.  <br /><br />The report emphasizes that pericardial effusions have many possible causes, including infection, malignancy, radiation, iatrogenic injury, metabolic and endocrine disorders, connective tissue disease, autoimmune disease, trauma, or idiopathic inflammation. Hemorrhagic effusions are most often associated with malignancy, tuberculosis, or iatrogenic causes, but the differential remains broad.  <br /><br />Key teaching points are that idiopathic pericarditis can lead to a large effusion and tamponade, fluid may appear hemorrhagic and exudative even without malignancy, and hemorrhagic effusions require treatment because of the risk of recurrence and constrictive pericarditis. Management after pericardiocentesis should be guided by the underlying cause.

Asset Subtitle

Forest Riekhof

Meta Tag

Author List Farzana Hoque, Forest Riekhof

Category Clinical Vignettes

Concept Hemorrhagic Pericardial Effusion

Concept Cardiac Tamponade

Concept Pericardial Effusion

Concept Beck Triad

Concept Idiopathic Pericarditis

Distinguished Non-Finalist

Presenter Organization Saint Louis University School of Medicine

Presenting Author Forest Riekhof

Track Adult

Keywords

cardiac tamponade

pericardial effusion

hemorrhagic effusion

idiopathic pericarditis

breast cancer

pericardiocentesis

Beck triad

exudative fluid

right atrial collapse

constrictive pericarditis

Hemorrhagic Pericardial Effusion

Cardiac Tamponade

Pericardial Effusion

Beck Triad

Idiopathic Pericarditis