title: Concurrent pericardial and pleural effusions: a double jeopardy.
abstract: A 19-year-old man with large malignant pleural and pericardial effusions with tamponade physiology and signs of congestive heart failure presented for emergent subxiphoid pericardial window. Surgical drainage of the pericardium was complicated by a paradoxical cardiovascular collapse that failed to respond to pressors and intravenous fluids. Suspecting a pericardial perforation, a median sternotomy was performed and revealed an intact heart. The arterial pressure was promptly restored after drainage of the pleural effusion. It is proposed that, in patients presenting with tamponading pericardial and pleural effusions, drainage of the pleural effusion be given priority. The pathophysiology of low cardiac output states resulting from pericardial and large pleural effusion is discussed and the literature reviewed.
authors.affiliation: Department of Anesthesiology, Albany Medical College, 47 New Scotland Ave, MC-131, Albany, NY 12208, USA. Electronic address: furstb@mail.amc.edu.
authors.forename: Branko
authors.initials: B
authors.lastname: Furst
authors.affiliation: Department of Anesthesiology, Albany Medical College, 47 New Scotland Ave, MC-131, Albany, NY 12208, USA. Electronic address: liuc@mail.amc.edu.
authors.forename: Chyong-Jy J
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, Albany Medical College, 47 New Scotland Ave, MC-131, Albany, NY 12208, USA. Electronic address: hansenp@mail.amc.edu.
authors.forename: Philip
authors.initials: P
authors.lastname: Hansen
authors.affiliation: Department of Anesthesiology, Albany Medical College, 47 New Scotland Ave, MC-131, Albany, NY 12208, USA. Electronic address: musukus@mail.amc.edu.
authors.forename: Sridhar R
authors.initials: SR
authors.lastname: Musuku
mesh_terms: D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000601:surgery; D004322:Drainage; D004452:Echocardiography; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010491:Pericardial Window Techniques; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D056346:Sternotomy; D055815:Young Adult
keywords: Anesthesia; Cardiovascular collapse; Pericardial tamponade; Pleural effusion; Right ventricular failure