Complicated pericardial effusion

Complicated pericardial effusion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Complicated pericardial effusion Tsai-Yan Lin, Yu-Tzu Chien, Yen-Tin Lin, Ping-Yi Lin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8710950/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Apr, 2026 Read the published version in The International Journal of Cardiovascular Imaging → Version 1 posted 8 You are reading this latest preprint version Abstract Pericardial effusion 1 is defined as excess fluid surrounding the heart, which may result from infection, malignancy, autoimmune disorders, trauma, heart disease, or idiopathic causes. Here, we present a case of complicated pericardial effusion with septal formation. Figures Figure 1 Figure 2 Case A 20-year-old woman with a history of asthma and cigarette smoking presented to our emergency department (ED) with a 2-week history of intermittent fever, chest pain, productive cough, and dyspnea. She reported owning a pet cat but denied any history of trauma, joint pain, skin rash, or weight loss. She had previously visited a local clinic, where she was prescribed oral medications; however, her symptoms persisted, prompting her to seek further care at our ED. On arrival, physical examination revealed fever and tachycardia without hypotension. Laboratory investigations showed elevated C-reactive protein (CRP) levels. Chest radiography revealed cardiomegaly without evidence of an endotracheal lesion (Figure 1A). Pulmonary ultrasonography demonstrated a left pleural effusion with septal formation (Figure 1B). Computed tomography revealed both pericardial and pleural effusions (Figure 1C). Transthoracic echocardiography demonstrated a complicated pericardial effusion with septal formation and a concomitant left pleural effusion (Figure 1D). During admission, pleural fluid analysis was consistent with an exudative effusion, autoimmune markers, tumor markers, HIV, and tuberculosis tests were all negative. A pericardial window was performed with successful drainage, and histopathological examination of the pericardium revealed inflammatory infiltration and abscess formation (Figure 2), confirmed the diagnosis of purulent pericarditis. Discussion Purulent pericarditis 2 is defined as an infection of the pericardial space and is now a rarely encountered condition. The diagnosis is usually confirmed by pericardiocentesis or a pericardial window procedure, both of which are also therapeutic. In our case, empirical antibiotic therapy was initiated following the procedure, and the patient ’ s clinical condition gradually improved. However, blood cultures and pericardial fluid cultures showed no bacterial growth. In addition, mycobacterial cultures remained negative after a two-month follow-up period. Based on these findings, a viral 3 etiology was presumed. Declarations Patient Consent for Publication Statement: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. The patient has been informed that personal identifiers will not be published, and efforts will be made to ensure anonymity, but complete anonymity cannot be guaranteed. Declaration of Generative AI and AI-Assisted Technologies in the Writing Process: During the preparation of this work, the authors utilized ChatGPT for English editing. After using ChatGPT, the authors reviewed and edited the content as necessary and take full responsibility for the content of the publication. Disclosure statement: I confirm that I have no relevant financial or personal conflicts of interest to disclose in relation to this matter. Funding statement: No support received for the present manuscript. References Willner DA, Goyal A, Grigorova Y, et al. Pericardial Effusion. [Updated 2024 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431089/ Costa L, Carvalho D, Coelho E, Leal D, Lencastre L. Purulent Pericarditis: Is It Really a Disease of the Past?. EJCRIM [Internet]. 2021 Jul. 14 [cited 2025 Dec. 20];8(7). Available from: https://www.ejcrim.com/index.php/EJCRIM/article/view/2658 Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015;314(14):1498–1506. doi: 10.1001/jama.2015.12763 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Apr, 2026 Read the published version in The International Journal of Cardiovascular Imaging → Version 1 posted Editorial decision: Revision requested 14 Mar, 2026 Reviews received at journal 06 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 27 Jan, 2026 Submission checks completed at journal 27 Jan, 2026 First submitted to journal 27 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8710950","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":585336057,"identity":"0f33d7b6-efcb-4a1f-ad25-d4471ce46edc","order_by":0,"name":"Tsai-Yan Lin","email":"","orcid":"","institution":"Tao Yuan General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tsai-Yan","middleName":"","lastName":"Lin","suffix":""},{"id":585336058,"identity":"26510b75-5ca2-4578-8b4c-aade444ab56a","order_by":1,"name":"Yu-Tzu Chien","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLCChAobHjZm5mNgDhs7IeVsQPzgTJocP3tbGlAzUICZCC2MD9sOG0v2nDEDa2EgpIV/fu8BhgS2tMQNN3K+Pfj4Y5s8HzMD44ePObi1SBzjS2BI4LEBasndbjgj4bZhGzMDs+TMbXisOcZjwJAgAbIld5s0T8JtRqAWNmZePFrkwVoMDoMc9gykxZ6gFgOwlgSw99lAWhIJajE8lgf0ywFwIJtJzki7ndzGzNiM1y9yh88eYPz5DxyVzyQ+2Ny2nd/efPDDR3zeZ+Bh/4EmwtiATz1ICwH5UTAKRsEoGAUAWiVOotpwzpoAAAAASUVORK5CYII=","orcid":"","institution":"Tao Yuan General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yu-Tzu","middleName":"","lastName":"Chien","suffix":""},{"id":585336059,"identity":"dfdf7b83-6f88-448f-ac7e-e5ca5348f1f7","order_by":2,"name":"Yen-Tin Lin","email":"","orcid":"","institution":"Tao Yuan General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yen-Tin","middleName":"","lastName":"Lin","suffix":""},{"id":585336060,"identity":"61131aaa-c65f-45b1-a748-fb89eda99718","order_by":3,"name":"Ping-Yi Lin","email":"","orcid":"","institution":"Tao Yuan General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ping-Yi","middleName":"","lastName":"Lin","suffix":""}],"badges":[],"createdAt":"2026-01-27 13:23:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8710950/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8710950/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10554-026-03721-w","type":"published","date":"2026-04-27T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":102180842,"identity":"55a4b0f3-e6d1-48c6-856a-2b4cd9254b73","added_by":"auto","created_at":"2026-02-09 07:15:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":578770,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8710950/v1/a157859065382299ca32d5ad.jpg"},{"id":102180841,"identity":"a6bc92e2-3dd4-4b91-aae4-edadad2424fb","added_by":"auto","created_at":"2026-02-09 07:15:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1408642,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8710950/v1/3dc32703ad9b46cc0cbc3f75.jpg"},{"id":108437999,"identity":"0a3301b3-684a-4528-80a4-6b8951349b44","added_by":"auto","created_at":"2026-05-04 16:05:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2082501,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8710950/v1/939a644d-8403-4c9f-8019-15452b587bea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Complicated pericardial effusion","fulltext":[{"header":"Case","content":"\u003cp\u003eA 20-year-old woman with a history of asthma and cigarette smoking presented to our emergency department (ED) with a 2-week history of intermittent fever, chest pain, productive cough, and dyspnea. She reported owning a pet cat but denied any history of trauma, joint pain, skin rash, or weight loss. She had previously visited a local clinic, where she was prescribed oral medications; however, her symptoms persisted, prompting her to seek further care at our ED. On arrival, physical examination revealed fever and tachycardia without hypotension. Laboratory investigations showed elevated C-reactive protein (CRP) levels. Chest radiography revealed cardiomegaly without evidence of an endotracheal lesion (Figure 1A). Pulmonary ultrasonography demonstrated a left pleural effusion with septal formation (Figure 1B). Computed tomography revealed both pericardial and pleural effusions (Figure 1C). Transthoracic echocardiography demonstrated a complicated pericardial effusion with septal formation and a concomitant left pleural effusion (Figure 1D). During admission, pleural fluid analysis was consistent with an exudative effusion, autoimmune markers, tumor markers, HIV, and tuberculosis tests were all negative. A pericardial window was performed with successful drainage, and histopathological examination of the pericardium revealed inflammatory infiltration and abscess formation (Figure 2), confirmed the diagnosis of purulent pericarditis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePurulent pericarditis\u003csup\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/sup\u003e is defined as an infection of the pericardial space and is now a rarely encountered condition. The diagnosis is usually confirmed by pericardiocentesis or a pericardial window procedure, both of which are also therapeutic. In our case, empirical antibiotic therapy was initiated following the procedure, and the patient\u003cspan dir=\"RTL\"\u003e\u0026rsquo;\u003c/span\u003es clinical condition gradually improved. However, blood cultures and pericardial fluid cultures showed no bacterial growth. In addition, mycobacterial cultures remained negative after a two-month follow-up period. Based on these findings, a viral\u003csup\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/sup\u003e etiology was presumed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Consent for Publication Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. The patient has been informed that personal identifiers will not be published, and efforts will be made to ensure anonymity, but complete anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Generative AI and AI-Assisted Technologies in the Writing Process:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work, the authors utilized ChatGPT for English editing. After using ChatGPT, the authors reviewed and edited the content as necessary and take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI confirm that I have no relevant financial or personal conflicts of interest to disclose in relation to this matter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo support received for the present manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Willner DA, Goyal A, Grigorova Y, et al. Pericardial Effusion. [Updated 2024 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK431089/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK431089/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Costa L, Carvalho D, Coelho E, Leal D, Lencastre L. Purulent Pericarditis: Is It Really a Disease of the Past?. EJCRIM [Internet]. 2021 Jul. 14 [cited 2025 Dec. 20];8(7). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ejcrim.com/index.php/EJCRIM/article/view/2658\u003c/span\u003e\u003cspan address=\"https://www.ejcrim.com/index.php/EJCRIM/article/view/2658\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015;314(14):1498\u0026ndash;1506. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2015.12763\u003c/span\u003e\u003cspan address=\"10.1001/jama.2015.12763\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-international-journal-of-cardiovascular-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caim","sideBox":"Learn more about [The International Journal of Cardiovascular Imaging](https://www.springer.com/journal/10554)","snPcode":"10554","submissionUrl":"https://submission.nature.com/new-submission/10554/3","title":"The International Journal of Cardiovascular Imaging","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8710950/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8710950/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePericardial effusion\u003csup\u003e1\u003c/sup\u003e is defined as excess fluid surrounding the heart, which may result from infection, malignancy, autoimmune disorders, trauma, heart disease, or idiopathic causes. 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