title: An unusual cause of dysphagia: pericardial effusion after implantable cardioverter-defibrillator placement.
abstract: BACKGROUND
  Dysphagia is a known complication of pericardial effusions. Most cases of pericardial effusions are idiopathic, infectious, and neoplastic, but can also occur after cardiac procedures.
  
  
  OBJECTIVE
  To report the case of a patient who developed dysphagia from a sub-acute pericardial effusion caused by the placement of an implantable cardioverter-defibrillator (ICD).
  
  
  METHODS
  A 62-year-old woman presented to the Emergency Department (ED) with a 2-day history of dysphagia. Imaging revealed a large pericardial effusion compressing the esophagus from the mid-thoracic level to the gastroesophageal junction. Ten days prior, a dual-chamber ICD with small-diameter active fixation leads was placed in the patient. There had been no apparent complications from the procedure, however, over this 10-day period she developed a sub-acute pericardial effusion from an incidental perforation during ICD lead placement that led to the extrinsic compression of the esophagus and her presenting symptom of dysphagia. The patient underwent pericardiocentesis for the pericardial effusion and she was discharged in stable condition.
  
  
  CONCLUSIONS
  This case report highlights the importance of recognizing a non-cardiac complaint such as dysphagia as the primary symptom of a critical cardiac condition. With an increase in cardiac procedures anticipated, clinicians should consider the possibility of a pericardial effusion as a cause of dysphagia, especially for those patients with recent cardiac procedures.
authors.affiliation: Department of Emergency Medicine, Memorial Hospital, South Bend, Indiana 46601, USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Chauhan
authors.forename: Minhaj S
authors.initials: MS
authors.lastname: Khaja
authors.forename: Vinod
authors.initials: V
authors.lastname: Chauhan
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hallett
authors.forename: Joseph
authors.initials: J
authors.lastname: Miller
authors.forename: Harsha
authors.initials: H
authors.lastname: Musunuru
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
mesh_terms: D017147:Defibrillators, Implantable / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology*