case_images: PMC4488084_01
case_images: (a), (b) Transthoracic echocardiogram (apical (a) and parasternal short-axis (b)) before pericardiocentesis: two large, loculated pericardial effusions (blue arrows) are noted with significant indentations of the right and left ventricular free wall. (c) Pulsed-wave Doppler interrogation of mitral valve inflow on transthoracic echocardiogram: evidence of significant (>25%) reduction in mitral valve E velocity (orange arrows) consistent with constrictive physiology after pericardiocentesis. (d) Cardiac magnetic resonance imaging following gadolinium administration revealed diffuse pericardial thickening and delayed enhancement (yellow arrows) after pericardiocentesis.
case_images: CRIM2015-193272.001.jpg
case_images: PMC4488084_01_CRIM2015-193272.001.jpg
case_images: fig1
case_images: He was diagnosed with bilateral pleural effusions and loculated pericardial effusions (Figures 1(a) and 1(b)). Echocardiography after pericardiocentesis revealed evidence of constrictive physiology (Figure 1(c)) and MRI demonstrated pericardial thickening with delayed enhancement (following administration of gadolinium), suggesting the presence of active inflammation and/or fibrosis (Figure 1(d)).
case_images: (a), (b) Transthoracic echocardiogram (apical (a) and parasternal short-axis (b)) showing resolution of pericardial effusion (blue arrows) after 10 weeks of IV Penicillin. (c) Pulsed-wave Doppler interrogation of mitral valve inflow on transthoracic echocardiogram: normal variation of mitral valve E velocity (orange arrows), suggesting normalization of pericardial pressure.
case_images: CRIM2015-193272.002.jpg
case_images: PMC4488084_01_CRIM2015-193272.002.jpg
case_images: fig2
case_images: On follow-up, the patient had no recurrence of effusions (Figures 2(a) and 2(b)). Repeat echocardiography performed 10 weeks after initiation of intravenous antibiotics confirmed resolution of constrictive physiology (Figure 2(c)).