Loculated pericardial effusion successfully managed with a right parasternal pericardiocentesis

Abstract

A 46-year-old woman with a previous diagnosis of inoperable stage IV small cell lung cancer presented to the emergency department with shortness of breath. Physical examination showed apale woman who appeared malnourished. Her vital signs were as follows: pulse rate 115 beats/min,respiration rate 22 breaths/min, body temperature 37.5°C, and blood pressure 95/65 mm Hg. Breathsounds were diminished on the left base and widespread coarse crackles were heard over the leftlung. Other system examination fi ndings were within normal limits. A 12-lead electrocardiogramshowed sinus tachycardia and lower voltage without marked ST changes. A chest X-ray showedinfi ltrates on the left upper zones, and a large left-sided pleural effusion (Figure 1A). Transthoracicechocardiograpy (TTE) showed a large loculated pericardial effusion measuring 3.2 cm inmaximal width on the right side of the heart with cardiac tamponade, which was also confi rmedby multislice computed tomography (Figure 1B). Due to the increased risk of general anesthesia.