Gone without a Trace: A Rare Case of Pericardial Effusion Resolving after Cardiopulmonary Resuscitation

Abstract

Abstract Pericardial effusion is collection of fluid in pericardial space. It is commonly seen as a part of multisystem infections, malignancy, and renal failure. It can progress to life-threatening pericardial tamponade, leading to cardiac arrest. Cardiopulmonary resuscitation (CPR) is well-established protocol for all types of cardiac arrests. CPR serves as a therapeutic intervention, reversing cardiac arrest and providing time to address the underlying cause. However, CPR can involve multiple complications, including thoracic skeleton and organ injuries. In this case report, we present a case of massive pericardial effusion in a male patient who was admitted to our hospital with abdominal pain and a medical history of diabetes, hypertension, ischemic heart disease, acute kidney injury, and coagulopathy. Massive pericardial effusion was identified using point-of-care ultrasonography (POCUS) of the heart. While his coagulation abnormalities were being corrected, he had a cardiac arrest in intensive care unit before any invasive intervention could be performed for pericardial effusion. Return of spontaneous circulation was achieved, and surprisingly, post-CPR POCUS of the heart did not reveal much evidence of pericardial effusion. The resolution of pericardial effusion was also confirmed with computed tomography of the chest once the patient was stabilized. We observe that the pleural effusion, initially minimal, increased following CPR. Thus, we report this interesting case to highlight the unintended therapeutic effect of CPR on pericardial effusion. In addition, we emphasize the importance of POCUS during critical care situations as it assisted us in avoiding blind pericardiocentesis and the potential traumatic complications associated with such a procedure.