title: Pericardial infusion of tissue plasminogen activator in fibropurulent pericarditis.
abstract: A 61-year-old man developed a loculated fibropurulent pericarditis, a rare complication of bacteremia. This occurred as a complication of a Staphylococcal aureus bacteremia from a head and neck abscess following self-extraction of a tooth. Despite surgical intervention and placement of 2 pericardial drains, a refractory, inadequately drained infected pericardial effusion persisted. Although there is limited experience with thrombolytic therapy to dissolve a fibrin clot in the pericardium, break down loculated adhesions, and facilitate free drainage of infected material, lysis is well described in the management of exudative pleural effusions. After infusion of 30 mg of tissue plasminogen activator in 100 cc normal saline through the pericardial drain of the patient, a large amount of infected serosanginous material subsequently drained during the next 2 days. The patient became afebrile and culture negative, remained hemodynamically stable, and had resolution of his pericarditis and pericardial effusion on electrocardiogram and echocardiogram, respectively.
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Reznikoff
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Fish
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Coursin
mesh_terms: D000038:Abscess / Q000150:complications; D016470:Bacteremia / Q000150:complications; D004322:Drainage; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005355:Fibrosis; D006801:Humans; D007263:Infusions, Parenteral; D007322:Instillation, Drug; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000150:complications; D010490:Pericardial Effusion / Q000382:microbiology; D010491:Pericardial Window Techniques; D020519:Pericardiocentesis; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications; D013211:Staphylococcus aureus; D013492:Suppuration; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D014081:Tooth Extraction / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator