Purulent pericarditis, an unusual cause of cardiac arrest

Abstract

Purulent pericarditis is a rare infection of the pericardial space defined by the presence of gross pus or microscopic purulence. Here, we present a case of Streptococcus anginosus purulent pericarditis, leading to obstructive and septic shock. After prompt pericardial drainage, the patient experienced rapid improvement in symptoms. However, due to the presence of a loculated effusion and concern for development of constrictive pericarditis, a pericardial window was performed. Although purulent pericarditis is often fatal, this case illustrates the reduced morbidity following prompt recognition and drainage.

Keywords: adult intensive care; infectious diseases; pericardial disease.

Figure 1

Post Advanced cardiac life support (ACLS) pericardiocentesis fluid.

Figure 2

Subxiphoid transthoracic echocardiogram displaying impaired right ventricle filling due to large pericardial effusion.

Figure 3

Brown pericardial following bedside pericardiocentesis and drain insertion.

Figure 4

CT chest: small to moderate sized pericardial effusion with pericardial drain in situi patchy and ‘tree-in-bud’ opacities within the upper lobe of the right lung. Bilateral pleural effusions.