A successfully treated case of primary purulent pericarditis complicated by cardiac tamponade and pneumopericardium

Abstract

Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is lifethreatening. A multimodality approach is required for proper diagnosis and treatment of this disease.

Keywords: Cardiac tamponade; Pericardiocentesis; Pericarditis; Streptococcus anginosus.

Figure 1.

Baseline examination. (A) Chest radiography showing marked cardiomegaly with 70% cardiothoracic ratio and bilateral pleural effusion. (B) Electrocardiogram showing low-voltage QRS and diffuse ST elevation.

Figure 2.

Changes in chest computed tomography (Chest CT) and echocardiogram. (A) Chest CT scan showing compression of the right ventricle (white arrows) due to pericardial effusion. (B) Transthoracic echocardiogram showing massive pericardial effusion. (C) After pericardiocentesis, transthoracic echocardiogram showing a decreased amount of pericardial effusion. (D) Chest CT scan showing loculated pericardial effusion with multi-focal air bubbles (white arrows) in the pericardial space.

Figure 3.

Surgical finding. (A) Pericardiostomy through the subxiphoid approach. (B) Pericardial effusion with grayish pus.