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A Brisk and Life-Saving Diagnosis of Pericardial Effusion as the Cause for Recurrent Dyspnea.

ABSTRACT: Point of care ultrasound (POCUS) is a reliable diagnostic tool for the evaluation of a patient with dyspnea. This case provides an example of an acutely dyspneic patient in which standard evaluation failed to elucidate the true etiology of the patient's dyspnea. The patient was initially diagnosed with pneumonia but returned to the emergency department with acute worsening of his symptoms despite empiric antibiotics leading to the presumption of antibiotic failure. POCUS revealed a large pericardial effusion requiring pericardiocentesis ultimately leading to the accurate diagnosis. This case highlights the importance of POCUS in evaluating patients with shortness of breath.

SUBMITTER: Sundberg JE

PROVIDER: S-EPMC9979900 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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A Brisk and Life-Saving Diagnosis of Pericardial Effusion as the Cause for Recurrent Dyspnea.

Sundberg Jacob E JE Mehta Ankit A

POCUS journal 20220421 1

Point of care ultrasound (POCUS) is a reliable diagnostic tool for the evaluation of a patient with dyspnea. This case provides an example of an acutely dyspneic patient in which standard evaluation failed to elucidate the true etiology of the patient's dyspnea. The patient was initially diagnosed with pneumonia but returned to the emergency department with acute worsening of his symptoms despite empiric antibiotics leading to the presumption of antibiotic failure. POCUS revealed a large pericar ...[more]

PMID: 36896275

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Project description:BackgroundWe evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT).MethodsThis was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups.ResultsAll patients were diagnosed as having exudative PE by Light's criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light's criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4-26.0] vs 17.4 [IQR, 13.7-26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012).ConclusionsLower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.

Dataset Information

A Brisk and Life-Saving Diagnosis of Pericardial Effusion as the Cause for Recurrent Dyspnea.

Publications

A Brisk and Life-Saving Diagnosis of Pericardial Effusion as the Cause for Recurrent Dyspnea.

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