Publish in this journal
Journal Information
Vol. 44. Issue 1.
Pages 66-67 (January - February 2020)
Download PDF
More article options
Vol. 44. Issue 1.
Pages 66-67 (January - February 2020)
Images in Intensive Medicine
DOI: 10.1016/j.medine.2019.02.012
Full text access
Massive Pericardial Effusion with Cardiac Tamponade
Derrame pericárdico masivo y taponamiento cardíaco
Ching-Hui Sia
Corresponding author

Corresponding author. 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228.
, Marjorie Arong, William Kok-Fai Kong
Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
Article information
Full Text
Download PDF
Figures (1)
Additional material (1)
Full Text

A 43-year-old man presented to the emergency department with a 2 week history of progressive breathlessness and fatigue. Physical examination revealed hypotension, tachycardia, jugular venous distension, pulsus paradoxus, and muffled heart sounds. His blood pressure was 90/60mm Hg, and the heart rate was 110 beats per minute. Chest x-ray showed a “water bottle configuration” suggestive of pericardial effusion (Fig. 1A). His electrocardiogram showed sinus tachycardia with small voltage QRS complexes and a degree of electrical alternans (Fig. 1B). Transthoracic echocardiography (TTE) revealed a large global pericardial effusion measuring>40mm in diameter with swinging of the heart freely in an anterior–posterior fashion (Fig. 1C, see video) and collapse of the right and left atria in end diastole, which was consistent with cardiac tamponade. Spectral Doppler demonstrated exaggerated respiratory variations of the mitral and tricuspid in-flow Doppler consistent with increased intrapericardial pressure and tamponade (Fig. 1D). A single axial, contrast-enhanced CT scan of the chest at the level of the heart showed a massive pericardial effusion (white arrows) surrounding the contrast-filled heart (LV=left ventricle) (Fig. 1E). The patient was immediately transferred to the coronary care unit where an emergency pericardiocentesis was performed which successfully drained 2.4 litres of serous pericardial fluid with immediate improvement of hemodynamics. Subsequent analysis showed a transudative pericardial fluid. All the connective tissue, cancer and infective markers were all negative and a diagnosis of idiopathic pericardial effusion was made. The patient was discharged well with resolution of the pericardial effusion on repeat TTE 4 days later. At 3 and 6 months follow-up, the patient was asymptomatic and well.

Figure 1
Declaration of Interest



All authors have contributed to the conception and design of the study, acquisition of data and analysis and interpretation of data. We drafted the article and revised it and approved the final version to be submitted.

Copyright © 2019. Elsevier España, S.L.U. and SEMICYUC
Medicina Intensiva (English Edition)

Subscribe to our newsletter

Article options
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.