Case 8: Pericardial Effusion
A 45-year-old male was admitted with fever (for two weeks), dyspnea, and pleuritic chest pain. Vital signs included temperature = 38.5, systolic blood pressure = 100/70 mmHg, heart rate = 90/min, and O2 saturation = 85% without an oxygen supply (90% with nasal oxygen therapy). ECG showed sinus tachycardia, no significant changes of ST segment, low voltage waves in limb leads, and QRS alternans. TTE revealed normal LV size and function, without regional wall motion abnormalities, and a circumferential pericardial effusion without significant respiratory variation on mitral and tricuspid valves (Figure 4). Lung CT scan showed bilateral GGO in favor of viral pneumonia (Figure 1H). The patient received IV broad-spectrum antibiotics (meropenem and doxycycline), high-dose corticosteroid (1 mg/kg methylprednisolone/day), and remdesivir for COVID-19. However, pericardial effusion was relieved on the third day after admission. The oxygen saturation increased to 95% (without oxygen supplement) after five days. He was discharged in good condition. Following up the patient for three months showed mild pericardial effusion and normal size and function of the right ventricle.