Rattray Cameron, Moughnyeh Mohamad, Fateh Jibran, Lee Michael
Henry Ford Providence Hospital, Southfield, MI, USA.
J Cardiothorac Surg. 2025 Jun 25;20(1):274. doi: 10.1186/s13019-025-03411-z.
Hepatic-pericardial fistulas are extremely rare complications typically arising from hepatic abscesses, trauma, or invasive procedures. These fistulas can lead to clinical manifestations such as pericarditis, cardiac tamponade, and septic shock. We report a case of purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex cardiac and oncologic history.
A 76-year-old man with a history of pancreatic, renal cell and prostate cancer presented with acute chest pain and dyspnea. Initial investigations revealed a moderate pericardial effusion and a suspicious hepatic lesion. The patient developed cardiac tamponade and underwent emergency pericardiocentesis, draining 750 ml of purulent fluid. A CT-guided biopsy confirmed a hepatic abscess with fistulization to the pericardium. Despite antibiotic therapy and drainage procedures, the patient's condition deteriorated, resulting in septic shock and death.
This case highlights the challenges in managing hepatic-pericardial fistulas, particularly in patients with significant comorbidities. Bacteroides fragilis was identified as the causative pathogen, which underscores the importance of timely identification and management of these rare infections. Early surgical intervention and targeted antibiotic therapy are critical, although prognosis remains poor in patients with compromised cardiovascular and respiratory status.
Hepatic-pericardial fistulas, though rare, should be considered in patients with unexplained pericarditis or septic shock, particularly in the presence of hepatic abscesses. Early recognition, multidisciplinary management, and individualized treatment are essential to improve outcomes.
肝心包瘘是极为罕见的并发症，通常由肝脓肿、外伤或侵入性操作引起。这些瘘可导致心包炎、心脏压塞和感染性休克等临床表现。我们报告一例有复杂心脏和肿瘤病史的患者因肝心包瘘继发脓性心包炎和感染性休克的病例。
一名76岁男性，有胰腺癌、肾细胞癌和前列腺癌病史，出现急性胸痛和呼吸困难。初步检查发现中度心包积液和一个可疑的肝脏病变。患者发生心脏压塞并接受了紧急心包穿刺，抽出750毫升脓性液体。CT引导下活检证实为肝脓肿并伴有心包瘘形成。尽管进行了抗生素治疗和引流操作，但患者病情仍恶化，导致感染性休克并死亡。
该病例突出了肝心包瘘治疗中的挑战，尤其是在有严重合并症的患者中。脆弱拟杆菌被确定为病原体，这凸显了及时识别和处理这些罕见感染的重要性。早期手术干预和针对性抗生素治疗至关重要，尽管心血管和呼吸功能受损的患者预后仍然很差。
肝心包瘘虽罕见，但对于不明原因的心包炎或感染性休克患者，尤其是存在肝脓肿时，应予以考虑。早期识别、多学科管理和个体化治疗对于改善预后至关重要。
