case_images: PMC10953104_01
case_images: Dental x-rays 2 weeks before the admission (A, maxillary teeth in upper panels, mandibular teeth in lower panels, right-side teeth in left panels, and left-side teeth in right panels), and dental x-rays before (B) and after (C) root canal treatment for chronic apical periodontitis in the first and second premolar teeth 2 months later. Pyocele-like alveolar bone resorption around the apex of mandibular first premolar tooth on the right side (arrows in A, B, and C) is noted in the background of diffuse gingival recession and alveolar bone resorption due to the old age.
case_images: 10.1177_23247096241239559-fig1.jpg
case_images: PMC10953104_01_10.1177_23247096241239559-fig1.jpg
case_images: fig1-23247096241239559
case_images: Two weeks before the referral visit at 86 years, he took oral new quinolone antibiotics for a week because he had painful periodontitis along a dental bridge in the mandibular premolar teeth on the right side (Figure 1A) and presented cheek swelling. He underwent dental treatment (Figure 1B, C), and the pericardial effusion resolved completely in a month.
case_images: Electrocardiogram (A), chest plain x-ray (B), and computed tomography (D, E) on the day of admission, fluorodeoxyglucose positron emission tomography (FDG-PET) 4 days later (F, G), and chest plain x-ray 11 days later at outpatient visit (C). Not regular sinus rhythm at pulse rate of 65 beats per minute with left bundle branch block and an isolated ventricular extrasystole (A), cardiac shadow enlargement which decreased spontaneously in 11 days (B, C), pericardial effusion (D, E) and coronary stent (arrow in D), and multiple uptake sites in the pericardium in the coronal image (F) and axial image (G) of FDG-PET.
case_images: 10.1177_23247096241239559-fig2.jpg
case_images: PMC10953104_01_10.1177_23247096241239559-fig2.jpg
case_images: fig2-23247096241239559
case_images: The chest plain x-ray film showed the dilation of cardiac shadow with obscured costophrenic angle on the left side (Figure 2B). Electrocardiogram showed regular sinus rhythm with wide QRS, indicative of the left bundle branch block (Figure 2A). The pericardial effusion and a small volume of pleural effusion on the left side were shown (Figure 2D, E). Whole-body 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) disclosed many spotty uptakes with the maximum of standardized uptake value (SUVmax) around 2.0 in the pericardial effusion (Figure 2F, G). Pericardiocentesis was planned as a diagnostic procedure but was not done based on the following reasons: (1) the patient was healthy at the old age and had no symptoms; (2) the volume of pericardial effusion tended to decrease from the initial visit (Figure 2B, 2C); (3) the heart showed good function of expansion in the present volume of pericardial effusion; and (4) the patient denied pericardiocentesis, based on his evaluation of the risk of the procedure.