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.