A common complaint does not always mean a common diagnosis

Abstract

An 83-year-old woman was referred to our Emergency Department (ED) for a chronic pericardial effusion with exertional dyspnoea that had been worse over the past several days. She denied any chest pain, syncope, fever, or leg swelling. She suffered from hypertension, heart failure NYHA I, diabetes mellitus type 2, and essential tremor treated with carvedilol, furosemide, olmesartan-hydrochlorothiazide, acetylsalicylic acid, and dapagliflozin. Her physical examination revealed no abnormalities. Her vital signs were blood pressure 130/70 mmHg, heart rate 70 bpm, peripheral oxygen saturation 95% in room ambient, and respiratory rate 18/min. Laboratory findings, including C-reactive protein and troponin T, were in the normal range. The electrocardiogram showed a sinus rhythm with normal atrioventricular conduction and ventricular repolarization. Point-of-care ultrasound documented an A-line pattern without pleural effusion and a diffuse and large (30 mm fluid strip) pericardial effusion without signs of cardiac tamponade and unchanged from the previous echocardiogram (Video 1). It also showed a large pulsing mass 6x6 cm close to the right atrium with a predominant systolic flow (Video 2, Video 3).

Keywords

• Pericardial effusion
• dyspnoea
• coronary artery fistula
• point-of-care ultrasound