Pericarditis complicated by recurrent cardiac tamponade

Abstract

Background. Pericarditis is a syndrome caused by various etiologies. It manifests through pain in the left side of the chest, fever or low-grade fever, ECG changes with newly developed diffuse ST-segment elevation or PR-segment depression, ECG changes, and elevated inflammatory markers such as ESR, leukocytosis, and CRP. Objective(s). To present the case of a female patient diagnosed with pericarditis complicated by recurrent cardiac tamponade of undefined origin, highlighting the diagnostic and establishing the correct treatment. Materials and methods. A 22-year-old female patient was repeatedly hospitalized at the IMSP Institute of Cardiology with dyspnea, fever (37.5°C), constrictive chest discomfort on inspiration, general fatigue, and loss of appetite. Investigations: ECG, transthoracic echocardiography, abdominal and thyroid ultrasound, chest CT scan, hematological and biochemical tests. Results. Clinical findings: BP 110/70 mmHg, HR 110 bpm, SpO₂ 94%, ECG: sinus rhythm. Transthoracic echocardiography revealed pericardial effusion: PPVS 20 mm, PLVS 15 mm, apex 9 mm, basal RA 10 mm, with signs of cardiac tamponade. Repeated pericardial punctures and drainage were performed due to recurrent episodes of tamponade. Rivalta reaction: +++, pleural fluid color: gray, no atypical cells detected. Chest CT scan revealed a mediastinal benign tumor on the left side (3.2 x 4.9 x 6.0 cm). Subsequently, the patient underwent surgery at the specialized hospital for benign tumor removal, with a favorable outcome and recovery. Conclusion(s). Pericarditis can have various etiologies and may affect different age groups. Proper treatment - anti-inflammatory, etiological, or surgical - can prevent severe complications such as constrictive pericarditis or cardiac tamponade. In this case, timely diagnosis led to a favorable outcome.