Pericardial Tamponade Masquerading as Septic Shock

Schuett, Amy; Davis, Mary E.; Ray, Tarang; Granato, Jerome E.

doi:10.1007/s11606-006-0038-7

Cited by 7 publications

(9 citation statements)

References 7 publications

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“…The finding of a polymicrobial pericarditis should raise suspicion for underlying causes: in these reports, polymicrobial pericarditis was either the result of an infection or direct pericardial perforation. Infections, either continuous (mediastinitis,11 15 16 periodontal,5 17 18 hepatic11 or myocardial14 abscesses and pneumonia19) or haematogenous (urosepsis10 and septic arthritis20) were most often described. Other causes include direct pericardial perforation (iatrogenic,7 21–23 swallowing of a fish bone,24 gunshot wound19 and foreign body25) or miscellaneous causes (oesophageal fistula,26–28 gastric ulcer,29 ulcerative carcinoma30 31 and a ruptured syphilitic aortic aneurysm19).…”

Section: Discussionmentioning

confidence: 99%

Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band

Jong¹,

Loenhout

Swank

et al. 2018

BMJ Case Reports

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We describe a case of polymicrobial bacterial pericarditis with and, caused by pericardial penetration of the tip of the catheter of a laparoscopic adjustable gastric band (LAGB). The patient developed a cardiac tamponade, and subsequently emergency pericardiocentesis was performed. Analysis of earlier CT scans showed that the tip of the catheter had migrated through the liver and through the diaphragm into the pericardium, and was in contact with the myocardium. After stabilisation he was operated to remove the LAGB. In this case report, we describe the chain of events that led to the polymicrobial pericarditis-a complication of LAGB placement that to our knowledge has thus far never been reported. We furthermore present a detailed literature review of all published cases of polymicrobial pericarditis and its causes.

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Section: Discussionmentioning

confidence: 99%

Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band

Jong¹,

Loenhout

Swank

et al. 2018

BMJ Case Reports

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“…It can be difficult to diagnose because the signs and symptoms may be nonspecific and, as was the case with this patient, can mimic sepsis or septic shock. [1][2][3] Tamponade physiology is caused by the presence of a pericardial effusion large enough to create a pressure disequilibrium, causing obstruction of blood return and consequent chamber collapse. The American Society of Echocardiography approximates the size of a pericardial effusion roughly based on volume: small effusions defined as 50 to 100 mL, moderate effusions defined as 100 to 500 mL, and large effusions defined as > 500 mL of fluid.…”

Section: Discussionmentioning

confidence: 99%

A 50-Year-Old Woman Who Presents With Hypotension

Shah

Borodyanskiy

Ahmad

2018

Chest

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“…Cardiac tamponade can be misdiagnosed as severe sepsis or septic shock ( 5 , 6 ). This misdiagnosis might delay urgent pericardiocentesis that could promptly relieve life-threatening cardiac tamponade.…”

Section: Discussionmentioning

confidence: 99%

“…Low-pressure cardiac tamponade is an uncommon form of cardiac tamponade, as is the occurrence of cardiac tamponade as the first manifestation of malignancy ( 1 , 4 ). Also, cardiac tamponade can be initially misdiagnosed as sepsis or septic shock ( 5 , 6 ), and a high index of suspicion is necessary for appropriate management. Currently, the availability of bedside ultrasound in the emergency department (ED) has allowed for more rapid diagnosis of cardiac tamponade ( 7 ), and it is suggested that a bedside ultrasound should be done in patients diagnosed with sepsis or shock ( 7 , 8 ).…”

mentioning

confidence: 99%

Low-pressure cardiac tamponade masquerading as severe sepsis diagnosed with a bedside ultrasound and as the initial presentation of malignancy

Conti

Oppenheim

2014

Journal of Community Hospital Internal Medicine Perspectives

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ObjectiveWe report a patient with low-pressure cardiac tamponade masquerading as sepsis and as the initial presentation of malignancy. A quick diagnosis was done by the intensivist performing a bedside ultrasound.BackgroundThe diagnosis of low-pressure cardiac tamponade is a challenge because the classic physical signs of cardiac tamponade can be absent. It is made even more challenging when the vital sign changes and physical examination findings mimic severe sepsis. One of the benefits of a bedside ultrasound in the assessment of a patient with an initial diagnosis of severe sepsis or septic shock is the rapid diagnosis of cardiac tamponade if it is present.Data Source and SynthesisA 55-year-old male presented to the emergency department with weakness, cough, and syncope. His examination was notable only for dusky mottling of his cheeks, chest, and neck. Specifically, there was no jugular venous distension or pulsus paradoxus. A chest radiograph showed a right upper lobe infiltrate, whereas his electrocardiogram showed only sinus tachycardia. His white blood cell count and lactic acid were elevated. The sepsis protocol was started and a bedside ultrasound revealed signs of cardiac tamponade. The patient immediately improved after a pericardiocentesis. Analysis of the pericardial biopsy revealed adenocarcinoma, later determined to be from a pulmonary primary source.ConclusionsBecause low-pressure cardiac tamponade is life-threatening and difficult to diagnose, evaluation of the pericardium with a bedside ultrasound should be considered in patients with syncope, severe sepsis, or shock.

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Pericardial Tamponade Masquerading as Septic Shock

Cited by 7 publications

References 7 publications

Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band

Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band

A 50-Year-Old Woman Who Presents With Hypotension

Low-pressure cardiac tamponade masquerading as severe sepsis diagnosed with a bedside ultrasound and as the initial presentation of malignancy

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