The Syndrome of Cardiac Tamponade with “Small” Pericardial Effusion

Abstract

Cardiac tamponade is usually a consequence of increased pericardial pressure with accumulation of pericardial effusion. Pericardial effusion may be caused by acute pericarditis, tumor, uremia, hypothyroidism, trauma, cardiac surgery, or other inflammatory/noninflammatory conditions. In this article we describe four scenarios illustrated by case reports where a small or apparently small pericardial effusion may produce cardiac tamponade. The first scenario illustrates how a small pericardial effusion can cause clinically significant cardiac tamponade when it accumulates rapidly. The second scenario exhibits how an apparently small pericardial effusion on transthoracic echocardiogram (TTE) turned out to be a small amount of unclotted blood and an echogenic hematoma. The third scenario details how an apparently small pericardial effusion on TTE was actually a large loculated effusion in an unusual location seen only by transesophageal echocardiogram (TEE). The fourth scenario demonstrates how the combination of a large pleural effusion and a small pericardial effusion can result in cardiac tamponade. The role of echocardiography in the diagnosis and management of these scenarios is discussed here. Although many clinicians depend on the amount of pericardial effusion to suspect cardiac tamponade, it is important to suspect cardiac tamponade when patients have hemodynamic compromise regardless of the amount of pericardial effusion.

Thoracentesis-Reverting Cardiac Tamponade Physiology in a Patient with Myxedema Coma and Large Pleural Effusion

“…During intrapleural fl uid infusion, intrapleural and intrapericardial pressures rose in the same manner (6). Subsequently, other case reports demonstrated the development of clinical echocardiographic and Doppler ultrasound signs of cardiac tamponade in patients with pleural eff usions and otherwise insignifi cant pericardial eff usions; drainage of pleural fl uid in these patients resulted in hemodynamic improvement (6)(7)(8)(9). As in our report, the tamponade physiology resolution after pleural eff usion drainage strongly suggests a direct and signifi cant eff ect of concomitant large pleural eff usions in addition to mild to moderate pericardial eff usions in causing tamponade as a severe hemodynamic complication.…”

Pyopericardium progressing to tamponade in a patient with immune thrombocytopenia

“…Typically small effusions accumulate quickly and tend to produce tamponade. Large effusions, on the other hand, undergo slow accumulation of fluid, thereby allowing the pericardial sac to expand 12. Treatment is by drainage of pus, which may be done by pericardiocentesis, surgical pericardial window or pericardiectomy, along with antibiotic therapy.…”

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

“…However, non-complicated regional pericardial effusion or transudate as common adverse events after myocardial infarction could be difficult to be distinguished from pericarditis-related hemopericardium [10]. Traditional imaging modality like echocardiography is important for early detection and accurate diagnosis [11]. In this regard, characteristic description of the non-complicated regional pericardial fluid that helps differentiate the true "risky components" may help therapeutic strategy decision.…”