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      "titulo" => "Cardiac arrest secondary to odontoid fracture"
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    "titulo" => "Massive Pericardial Effusion with Cardiac Tamponade"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 43-year-old man presented to the emergency department with a 2 week history of progressive breathlessness and fatigue&#46; Physical examination revealed hypotension&#44; tachycardia&#44; jugular venous distension&#44; pulsus paradoxus&#44; and muffled heart sounds&#46; His blood pressure was 90&#47;60mm Hg&#44; and the heart rate was 110 beats per minute&#46; Chest x-ray showed a &#8220;water bottle configuration&#8221; suggestive of pericardial effusion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1A</a>&#41;&#46; His electrocardiogram showed sinus tachycardia with small voltage QRS complexes and a degree of electrical alternans &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1B</a>&#41;&#46; Transthoracic echocardiography &#40;TTE&#41; revealed a large global pericardial effusion measuring<span class="elsevierStyleHsp" style=""></span>&#62;40mm in diameter with swinging of the heart freely in an anterior&#8211;posterior fashion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1C</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0020">see video</a>&#41; and collapse of the right and left atria in end diastole&#44; which was consistent with cardiac tamponade&#46; Spectral Doppler demonstrated exaggerated respiratory variations of the mitral and tricuspid in-flow Doppler consistent with increased intrapericardial pressure and tamponade &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1D</a>&#41;&#46; A single axial&#44; contrast-enhanced CT scan of the chest at the level of the heart showed a massive pericardial effusion &#40;white arrows&#41; surrounding the contrast-filled heart &#40;LV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>left ventricle&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1E</a>&#41;&#46; The patient was immediately transferred to the coronary care unit where an emergency pericardiocentesis was performed which successfully drained 2&#46;4 litres of serous pericardial fluid with immediate improvement of hemodynamics&#46; Subsequent analysis showed a transudative pericardial fluid&#46; All the connective tissue&#44; cancer and infective markers were all negative and a diagnosis of idiopathic pericardial effusion was made&#46; The patient was discharged well with resolution of the pericardial effusion on repeat TTE 4 days later&#46; At 3 and 6 months follow-up&#44; the patient was asymptomatic and well&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Declaration of Interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">None</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Disclosure</span><p id="par0025" class="elsevierStylePara elsevierViewall">All authors have contributed to the conception and design of the study&#44; acquisition of data and analysis and interpretation of data&#46; We drafted the article and revised it and approved the final version to be submitted&#46;</p></span></span>"
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