Lessons of the month 1: Cardiac tamponade: don't forget the pancreas

Abstract

Cardiac tamponade is a medical emergency, caused by rapid accumulation of fluid in the pericardium resulting in reduced ventricular filling which may result in pulmonary oedema, shock and death. The common causes of cardiac tamponade include malignancy, uraemia, infectious/idiopathic pericarditis, connective tissue diseases, post-cardiac surgery etc. Early recognition and treatment of the underlying cause of the tamponade along with pericardiocentesis improves the prognosis, otherwise untreated cardiac tamponade universally results in death. We report a rare case of 32-year-old man, who presented with cardiac tamponade due to a pancreatico-pericardial fistula secondary to pancreatitis and was successfully treated by endoscopic therapy.

Keywords: cardiac tamponade; endoscopic retrograde pancreatography; pancreatic fistula; pancreatitis.

Fig 1.

a) Chest X-ray showing cardiomegaly. b) Computed tomography of the chest showing large pericardial effusion and minimal pleural effusion. c and d) Computed tomography of the abdomen showing pancreatitis with peripancreatic fluid collection and extension of fluid collection up to the diaphragm.

Fig 2.

a) Pancreaticography showing contrast leak from the pancreatic duct and leak traversing towards the diaphragm and pericardium. b) Fluoroscopy showing pancreatic stent placed across the leak. c and d) Endoscopic image showing pancreatic sphincterotomy and pancreatic stent.

Fig 3.

a) Chest X-ray showing normal cardiac silhouette. b) Abdominal X-ray showing pancreatic stent.