Bubbles in the Pericardium

Patient: Male, 22 Final Diagnosis: Purulent pericardial effusion with tamponade Symptoms: Chest pain • short of breath Medication: None Clinical Procedure: Pericardial drainage Specialty: Cardiology OBJECTIVE: Rare disease BACKGROUND: Purulent pericarditis is a rare but life-threatening illness. Often, it may be masked by the primary infectious etiology like pneumonia, endocarditis, or CNS infection, leading to a delay in diagnosis and treatment. Echocardiography is the modality of choice for estimating the presence and size of pericardial effusion and detecting presence of tamponade. CASE REPORT: We present a case of a young man with acute respiratory illness in whom clinical exam, electrocardiography, and classic echocardiographic findings played a key role in diagnosis. An echo-dense effusion (rather than echo-free space) appearing like “bubbles” within the pericardial space was seen and a purulent nature of the fluid was strongly suspected. Prompt institution of antimicrobial therapy and timely pericardial drainage resulted in complete clinical recovery of the patient. CONCLUSIONS: In this case, timely diagnosis and prompt treatment of effusion with pericardial drainage and antibiotics resulted in complete recovery from this otherwise devastating infection.