A difficult-to-diagnose pericardial fistula.
Am J Med Sci
; 364(5): 669-672, 2022 11.
Article
in En
| MEDLINE
| ID: mdl-35718121
ABSTRACT
Pericardial fistula is a rare complication. Generally, the diagnosis can be confirmed by imaging examination, but our patient was an exception. We present a 71-year-old female patient that complained of remnant gastric cancer for five months and dyspnea for seven days; the dyspnea became aggravated during the last two days. After admission, emergency thoracic computed tomography and echocardiography showed pericardial effusion, and pericardiocentesis was performed. After conventional treatment, the pericardial effusion was unchanged and no cancer cells were found in the pericardial drainage. However, the color changed from turbid to golden yellow and, finally, to green. After 20 days of repeated laboratory, imaging, and gastrointestinal contrast examinations, no cause was found. Moreover, a clinical diagnosis could not be obtained following numerous comprehensive clinical analyses. Given the color change of the pericardial drainage, we strongly suspected pericardial fistula, but the imaging examinations were negative. Finally, a methylene blue test confirmed the existence of a pericardial fistula. When the color of the pericardial effusion changes, the existence of a pericardial fistula must be considered in advance, and other methods should be evaluated if imaging cannot assist in the diagnosis.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pericardial Effusion
/
Cardiac Tamponade
/
Fistula
Type of study:
Diagnostic_studies
/
Etiology_studies
Limits:
Aged
/
Female
/
Humans
Language:
En
Journal:
Am J Med Sci
Year:
2022
Document type:
Article
Affiliation country:
China