Journal Article

The unmasking of a pyopericardium

Ail, Dhiraj, Cracknell, Benjamin Robert Syer

2015

Overview

Pyopericardium is a rare condition with a high mortality rate in which infection propagates in the pericardial space, leading to a pus filled pericardial effusion and cardiac tamponade, which can cause cardiogenic shock and death. We present a case of a previously healthy woman of 52, who was admitted with a severe lower respiratory tract infection that eventually led to a pyopericardium. The diagnosis of pyopericardium was delayed due to masking of symptoms by her underlying infection, sepsis and an upper gastrointestinal bleed that the patient suffered during the admission, requiring an emergency gastroscopy. The pyopericardium was considered when ST elevation was seen on an ECG and an ECHO discovered a large pericardial effusion causing tamponade. An emergency pericardiocentesis drained frank pus. Treatment with intravenous antibiotics, frequent pericardial drainage and a pericardectomy led to an excellent outcome, and a full recovery.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: 51-70 years / Abdomen / Acute coronary syndromes / Alcohol / Anti-Bacterial Agents - therapeutic use / Antibiotics / Blood pressure / Cardiac Tamponade - diagnosis / Cardiac Tamponade - etiology / Cardiac Tamponade - therapy / Catheters / Creatinine / Delayed Diagnosis / Drainage / Echocardiography / Edema / Electrocardiography / Female / Fluids / Hemoglobin / Humans / Infections / Middle Aged / Mortality / Pain / Pericardial Effusion - diagnosis / Pericardial Effusion - etiology / Pericardial Effusion - therapy / Pericardiectomy / Pericarditis / Pericardium / Physical therapy / Pneumonia / Rare Disease / Respiratory Tract Infections - complications / Sepsis / Suppuration - diagnosis / Suppuration - etiology / Suppuration - therapy / Thoracic surgery / Treatment Outcome / Ulcers / United Kingdom / White / X-rays