Systemic chemotherapy in combination with pericardial window
has better outcomes in malignant pericardial effusions.
There does not appear to be a need for more invasive procedures, such as a thoracotomy or pericardial window
, given the success and lack of complications with minimally invasive techniques.
Abdominal ultrasound demonstrated a flattened IVC and significant abdominal ascites, so a subxiphoid pericardial window
(to exclude pericardial tamponade) was performed and bilateral thoracostomy tubes were placed to ensure that extrinsic compression was not the cause of right atrial underfilling.
Loculated effusions and effusions containing clots increase the risks of closed pericardiocentesis, mainly perforation of the ventricle; in these instances an open approach is more desirable, both for safety and to obtain pericardial tissue and create a pericardial window
Past medical history includes end stage renal disease on hemodialysis therapy, heart failure with preserved ejection fraction, permanent atrial fibrillation, severe pulmonary hypertension, and pericardial effusion with placement of pericardial window
. Physical examination revealed blood pressure of 117/59 mmHg, heart rate of 91 bpm, respiratory rate of 18 per minute, O2 sat of 96% on room air, and temperature of 37[degrees]C.
Given the evidence for persistent infection, he was taken to the operating room for a pericardial window
, washout, and pericardial drain placement with subsequent clinical improvement.