Verma Somil, Agrawal Chirag, Gupta Puneet, Gupta Anunay
Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi-110029, India.
Eur Heart J Case Rep. 2024 Sep 19;8(9):ytae482. doi: 10.1093/ehjcr/ytae482. eCollection 2024 Sep.
Amoebiasis is a prevalent infection in the tropics and can sometimes present as liver abscess. Cardiac tamponade is an uncommon complication of ruptured amoebic liver abscess requiring urgent pericardiocentesis, which has a high success rate, but procedural complications can include injury to cardiac chambers, abdominal viscera, and even death. This case underscores the approach to diagnose and manage an unintended visceral puncture during pericardiocentesis, which is a rare but life-threatening complication.
A 41-year-old male presented with intermittent fever over 2 months and chest pain for 15 days. Echocardiography revealed a significant pericardial effusion causing cardiac tamponade. In an emergency setting, percutaneous pericardiocentesis was attempted to drain the effusion. However, the pigtail inadvertently punctured a sizable liver abscess. Consequently, another pigtail was inserted into the pericardial cavity to successfully drain the effusion. Patient was discharged on Day 12 and is doing well at 6 months follow-up.
A previously undiagnosed case of a ruptured amoebic liver abscess presented with the uncommon complication of cardiac tamponade, necessitating emergency pericardiocentesis, which inadvertently led to the cannulation of the liver abscess. This case underscores the significance of image-guided pericardiocentesis in minimizing procedural complications. This case also highlights the intricacies of addressing accidental visceral puncture during pericardiocentesis, specially involving the liver. It also underscores the need to consider the possibility of a ruptured amoebic liver abscess when anchovy sauce-like pus is drained from pericardial cavity, especially in high epidemiologically prevalent country like India.
阿米巴病在热带地区是一种常见感染，有时可表现为肝脓肿。心脏压塞是阿米巴肝脓肿破裂的一种罕见并发症，需要紧急进行心包穿刺术，该手术成功率较高，但操作并发症可能包括心脏腔室、腹部脏器损伤，甚至死亡。本病例强调了心包穿刺术期间诊断和处理意外内脏穿刺的方法，这是一种罕见但危及生命的并发症。
一名41岁男性，持续发热2个多月，胸痛15天。超声心动图显示大量心包积液导致心脏压塞。在紧急情况下，尝试进行经皮心包穿刺术引流积液。然而，猪尾导管意外穿刺了一个较大的肝脓肿。因此，另一个猪尾导管插入心包腔成功引流积液。患者于第12天出院，6个月随访时情况良好。
一例先前未诊断出的阿米巴肝脓肿破裂病例出现了罕见的心脏压塞并发症，需要紧急进行心包穿刺术，该操作意外导致肝脓肿插管。本病例强调了影像引导下心包穿刺术在减少操作并发症方面的重要性。本病例还突出了心包穿刺术期间处理意外内脏穿刺的复杂性，特别是涉及肝脏时。它还强调，当从心包腔引流出口袋状脓液时，尤其是在印度这样高流行率的国家，需要考虑阿米巴肝脓肿破裂的可能性。
