Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia.
BMJ Case Rep. 2024 Jan 12;17(1):e256908. doi: 10.1136/bcr-2023-256908.
We present the case of a woman in her 60s with Child-Pugh C cirrhosis who developed pericardial tamponade during an admission for a haemothorax secondary to a mechanical fall. The patient developed haemodynamic compromise with a rapid decline in renal function. During an open subxiphoid drain tube insertion, a pre-existing peritoneopericardial communication was noted, with ascites in the peritoneal cavity on view. The serum ascites albumin gradient was 14 g/L. Maximal medical therapy was commenced including diuresis and albumin, with adjunctive terlipressin infusion which restored her baseline renal function and resolved the effusion. We believe this is the first case report of using open drainage, maximal medical therapy and terlipressin to successfully treat hepatic hydropericardium and its subsequent renal compromise.
我们报告了一例 60 多岁的女性患者，患有 Child-Pugh C 级肝硬化，因机械性跌倒导致血胸入院时发生心包填塞。患者出现血流动力学不稳定，肾功能迅速下降。在进行开胸引流管插入时，发现存在先前存在的心包-腹膜交通，腹腔内可见腹水。血清腹水白蛋白梯度为 14g/L。开始进行最大程度的药物治疗，包括利尿剂和白蛋白，并辅助给予特利加压素输注，这恢复了她的基础肾功能并解决了积液问题。我们相信这是首例使用开放引流、最大程度的药物治疗和特利加压素成功治疗肝性心包积液及其随后的肾功能损害的病例报告。
