Isolated Left Atrial Cardiac Tamponade Caused by Pleural Effusion

Abstract

A localized left atrial tamponade caused by left side pleural effusion is a rare finding that leads to hemodynamic instability. Here, we describe left atrial systolic and diastolic collapse resulting from left pleural effusion. An increase in intrapleural pressure by a pleural effusion can compress the pericardial space and lead to impaired cardiac filling and tamponade physiology. Here, we present a case of a 79-year old African American female who presented with shortness of breath and dry cough for a duration of one week. Chest radiograph and CT scan of the chest showed left pleural effusion. The echocardiogram revealed left atrial systolic and diastolic collapse due to pleural effusion, which triggered cardiac tamponade physiology. With the guidance of a bedside thoracic ultrasound, she underwent a diagnostic and therapeutic thoracentesis which resolved her symptoms. Repeat echocardiogram revealed resolution of the cardiac tamponade with no further indication of left atrial diastolic collapse. In conclusion, pleural effusions can cause tamponade physiology and can be resolved by thoracentesis. Early recognition by a bedside point-ofcare ultrasound may help provide prompt relief of tamponade.

Postsurgical Left Atrial Compression due to Hemopericardium Resulting in Liver Failure: A Rare Cause of Cardiac Tamponade

“…4 , 5 , 6 Even a large left pleural effusion can cause left atrial diastolic collapse and mimic cardiac tamponade physiology. 7 Our case also demonstrated an abnormal motion of the LV, consistent with LV pseudodyskinesis. Although classically caused by extrinsic diaphragmatic or subdiaphragmatic compression of the inferior wall, pseudodyskinesis was demonstrated in our case, likely from local compression from the focal pericardial effusion.…”

Isolated left ventricular cardiac tamponade diagnosed on point‐of‐care ultrasound in the emergency department: A case report and brief literature review

“…5 even in the absence of RA or RV collapse. [7][8][9] In patients with loculated effusions or other localized compressive effects such as with esophageal stents or massive pleural effusions, as seen in other case reports, 10,11 the intrapericardial pressure exerted by the effusion only affects the adjacent chambers, which can potentially cause isolated left heart tamponade.…”

“…In patients with pulmonary hypertension, when right heart pressures are severely elevated, the intrapericardial pressure exerted by the circumferential effusion can overcome the diastolic pressure in the LV, causing LA or LV diastolic collapse even in the absence of RA or RV collapse 7–9 . In patients with loculated effusions or other localized compressive effects such as with esophageal stents or massive pleural effusions, as seen in other case reports, 10,11 the intrapericardial pressure exerted by the effusion only affects the adjacent chambers, which can potentially cause isolated left heart tamponade.…”