title: Massive pericardial effusion with left-to-right intracardiac shunt.
abstract: We describe a 31-year-old man with Down's syndrome who presented with severe chronic hypothyroidism and a massive pericardial effusion. Following partial aspiration of this effusion, he rapidly deteriorated and died. Findings at autopsy revealed him to have an atrioventricular septal defect with shunting at the atrial level. We postulate that, by releasing extrinsic pressure on his right heart by the aspiration, there was sudden shunting of blood from left-to-right, resulting in hypotension, shock, and subsequent death. We highlight the difficulties in management of such a case, and suggest alternative strategies.
authors.affiliation: Department of Radiology, Derriford Hospital, Plymouth, United Kingdom. edwards@horrabridge72.freeserve.co.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Edwards
authors.forename: N J
authors.initials: NJ
authors.lastname: Ring
authors.forename: A J
authors.initials: AJ
authors.lastname: Marshall
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004314:Down Syndrome / Q000150:complications; D006323:Heart Arrest / Q000209:etiology; D018610:Heart Bypass, Right / Q000009:adverse effects; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D008297:Male; D010490:Pericardial Effusion / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*