Intrapericardial urokinase irrigation and systemic corticosteroids: an alternative to pericardectomy for persistent fibrino-purulent pericarditis.
A 39-year-old man was admitted for upper abdominal pain and shortness of breath. The chest roentgenogram demonstrated cardiomegaly and left lower lobe atelectasis. Echocardiography showed circumferential pericardial effusion with signs of cardiac tamponade. Pericardial biopsy and fluid analysis were consistent with fibrino-purulent pericarditis. Despite broad-spectrum antibiotics, percutaneous and subsequently surgical drainage, pericardial effusion and tamponade recurred. We report successful treatment of a non-resolving fibrino-purulent pericardial effusion by combined intrapericardial irrigation of fibrinolytics and systemic corticosteroids administration as an alternative to pericardectomy.
Schafer
M
M
Intensive Care Division, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne CHUV, Switzerland.
Lepori
M
M
Delabays
A
A
Ruchat
P
P
Schaller
M-D
MD
Broccard
A F
AF
D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D010492:Pericardiectomy; D010493:Pericarditis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use*; D007507:Therapeutic Irrigation; D014463:Ultrasonography; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator; D011241:Prednisone