Jha Shikha
Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA.
Cureus. 2021 Dec 7;13(12):e20230. doi: 10.7759/cureus.20230. eCollection 2021 Dec.
Pericardial effusion is an important cardiac condition seen in clinical practice with several known underlying etiologies. We are aware of the challenge that exists in diagnosing the effusion. An interesting challenge that has caught our attention is the highest chance of missing the diagnosis if there is an atypical clinical presentation of the patient. In this case report, our objective is to discuss a case that enhances the importance of careful and meticulous investigation of a patient with an atypical clinical picture. This is a case report of a 92-year-old woman who presented to the emergency department with a chief complaint of upper back pain for a few days. She was found to have cardiomegaly on further imaging. An echocardiogram showed a moderate size pericardial effusion. Pericardiocentesis was done and a drain was left in place. Of note, the patient reported remarkable resolution of the back pain after the fluid was taken out. The serial echocardiogram post pericardiocentesis showed minimal drainage, hence the drain was taken out, and the patient was observed for clinical monitoring 24 hours post drain removal. A timely diagnosis and treatment saved our patient from the most dreadful life-threatening condition along with a secure discharge from the hospital.
心包积液是临床实践中常见的一种重要心脏疾病，有多种已知的潜在病因。我们深知诊断心包积液存在挑战。引起我们注意的一个有趣挑战是，如果患者临床表现不典型，漏诊的可能性最高。在本病例报告中，我们的目的是讨论一个病例，该病例凸显了对临床表现不典型的患者进行仔细、细致检查的重要性。这是一例92岁女性的病例报告，她因上背部疼痛数天为主诉就诊于急诊科。进一步影像学检查发现她有心脏扩大。超声心动图显示有中等量心包积液。进行了心包穿刺并留置了引流管。值得注意的是，抽出液体后患者报告背部疼痛明显缓解。心包穿刺术后的系列超声心动图显示引流极少，因此拔除了引流管，拔除引流管后对患者进行了24小时临床监测。及时的诊断和治疗使我们的患者避免了最可怕的危及生命的情况，并安全出院。
