Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Pericardial effusion – forgotten differential diagnosis of shortness of breath

Pankaj Garg
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.10-5-519a
Clin Med October 2010
Pankaj Garg
Clinical fellow cardiology Aintree Cardiac Centre University Hospital Aintree, Liverpool
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Editor – I read with great interest Nijjer et al's excellent paper (Clin Med February 2010 pp 88–90). Delayed pericardial effusion can also be related to primary lung tumours or haematological tumours.1 In acute medicine, when a patient with known left ventricular dysfunction presents with shortness of breath, the most obvious diagnosis is heart failure. However, I have recently seen a case of a 70-year-old gentleman who was known to have moderate left ventricular systolic dysfunction and atrial fibrillation. He was admitted acutely with symptoms and signs suggestive of decompensated heart failure. His presenting electrocardiogram (ECG) confirmed atrial fibrillation and had poor R-wave progression. He was started on intravenous diuretics and also rate control antiarrhythmic drugs. He responded slightly to treatment and was also noted to be hypoxic on air. His chest X-ray revealed pulmonary congestion with some right upper lobe consolidation and cardiomegaly. A computed tomography pulmonary angiogram was organised which showed gross pericardial effusion and also a primary lung tumour in the right upper lobe. Retrospective analysis of his serial chest X-ray revealed that his cardiomegaly had worsened markedly in two months.

If this gentleman had a bedside echocardiogram done on his presentation, his diagnosis would have been made immediately and a prompt treatment strategy could have been started. Therefore, it is prudent to consider pericardial effusion in a patient presenting with shortness of breath, globular heart on chest X-ray and poor R-wave progression on ECG, irrespective of past medical history. A suspicion of pericardial effusion should lead to prompt bedside echocardiogram by an echocardiographer or acute physician trained in basic skills of echocardiography.2

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk

  • © 2010 Royal College of Physicians

References

  1. ↵
    1. Roberts W
    . Pericardial heart disease: its morphologic features and its causes. Proc (Bayl Univ Med Cent) 2005; 18:38–55.
    OpenUrlPubMed
  2. ↵
    1. Tsutsui JM
    , Maciel RR, Costa JM, et al. Hand-carried ultrasound performed at bedside in cardiology inpatient setting - a comparative study with comprehensive echocardiography. J Cardiovasc Ultrasound 2004; 2:24.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Pericardial effusion – forgotten differential diagnosis of shortness of breath
Pankaj Garg
Clinical Medicine Oct 2010, 10 (5) 519; DOI: 10.7861/clinmedicine.10-5-519a

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Pericardial effusion – forgotten differential diagnosis of shortness of breath
Pankaj Garg
Clinical Medicine Oct 2010, 10 (5) 519; DOI: 10.7861/clinmedicine.10-5-519a
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
  • Response
  • Functional disorders and chronic pain
Show more Letters to the editor

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians