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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Unusual cause of pericardial effusion
  1. Ragai Fouda1,
  2. Hussam Ammar2,
  3. Elham Sobhy1,
  4. Amr M Amin3
  1. 1Department of Internal Medicine, Kasr Elaini Hospital-Faculty of Medicine-Cairo University, Cairo, Egypt
  2. 2Department of Medicine, University of Texas, Huoston, Texas, USA
  3. 3Department of Nuclear Medicine Unit, Nuclear Medicine unit, NEMROCK, Cairo, Egypt
  1. Correspondence to Dr Hussam Ammar, h_ammar68{at}yahoo.com

Summary

A 65-year-old Egyptian lady suffering from non-alcoholic liver cirrhosis was referred to our unit for evaluation of a massive pericardial effusion. Few weeks before presentation, she suffered from progressive abdominal distention and dyspnoea. She denied fever, rigors or other cardiorespiratory symptoms. Examination revealed shrunken liver, spleenomegaly and ascites. Chest was clear to auscultation and heart sounds were distant. Chest radiograph showed cardiomegaly and clear lung fields. Abdominal ultrasound confirmed the results of abdominal examination. Transthoracic echocardiogram (TTE) revealed a massive pericardial effusion (PEF) and rheumatic mitral stenosis. Chest tomography showed PEF and clear lung fields. One litre of exudate was removed via TTE-guided needle pericardiocentesis. A pericardio-peritoneal shunt was suspected, which was confirmed via a radioisotopic study. This case is among very few cases that reported PEF in a cirrhotic ascetic patient secondary to a radio-isotopically confirmed pericardio-peritoneal shunt in the literature.

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