case_images: PMC11788383_01
case_images: Echocardiography before pericardiocentesis (A) showing a large pericardial effusion (white arrow), with Doppler revealing significant respiratory variation of mitral inflow velocity (yellow arrows) consistent with tamponade. Repeat echocardiography immediately following pericardiocentesis (B) showing resolution of pericardial effusion and (C) no significant respiratory mitral valve inflow variation.
case_images: fcvm-11-1539900-g001.jpg
case_images: PMC11788383_01_fcvm-11-1539900-g001.jpg
case_images: F1
case_images: A repeat echocardiogram showed a resolution of the pericardial effusion and a resolution of RV wall inversion and respiratory inflow velocities (Figure 1).
case_images: CT imaging showing a (A) large mediastinal mass (red arrow) and pericardial effusion (yellow arrow) on presentation. Repeat CT angiography post-pericardiocentesis (B) redemonstrating a mediastinal mass (red arrow) abutting the right atrium and ventricle with significant narrowing of the superior vena cava (yellow arrow).
case_images: fcvm-11-1539900-g002.jpg
case_images: PMC11788383_01_fcvm-11-1539900-g002.jpg
case_images: F2
case_images: RV compression, significant narrowing of the main pulmonary arteries, and compression of the superior vena cava (Figure 2). Repeat echocardiogram showed minimal reaccumulation of pericardial fluid but redemonstrated the large mediastinal mass, with compression of the right ventricle causing significant respiratory inflow variability in the mitral valve (40%), tricuspid valve (30%), and aortic valve (20%) spectral Doppler velocities with septal bounce that was concerning for tamponade physiology (Figure 3).
case_images: Echocardiography on hospital day 2 illustrating a large mass abutting the right ventricle (A, white arrow), with M mode demonstrating a diastolic collapse of the right ventricular wall (red highlight). Mitral valve Doppler (B) showing persistent respiratory variation of mitral valve inflow (yellow arrows), consistent with recurrent tamponade physiology despite resolution of the pericardial effusion.
case_images: fcvm-11-1539900-g003.jpg
case_images: PMC11788383_01_fcvm-11-1539900-g003.jpg
case_images: F3
case_images: RV compression, significant narrowing of the main pulmonary arteries, and compression of the superior vena cava (Figure 2). Repeat echocardiogram showed minimal reaccumulation of pericardial fluid but redemonstrated the large mediastinal mass, with compression of the right ventricle causing significant respiratory inflow variability in the mitral valve (40%), tricuspid valve (30%), and aortic valve (20%) spectral Doppler velocities with septal bounce that was concerning for tamponade physiology (Figure 3).