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case_images: Diagnostic assessments during the initial emergency unit presentation. (A) Electrocardiography displaying sinus tachycardia. (B) Chest X-ray illustrating an enlarged cardiac silhouette. (C) Laboratory results indicating leucocytosis and thrombocytosis.
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case_images: An electrocardiogram revealed sinus tachycardia and relatively low voltage on limb leads (Figure 1A), along with an enlarged cardiac silhouette and bilateral pleural effusion evident on chest X-ray (Figure 1B). Laboratory results revealed leucocytosis and thrombocytosis, as the following: haemoglobin 14.3 g/dL (normal range 13-15 g/dL), leucocyte count 41,400/muL (normal range 5000-10,000/muL), and total platelet count of 687,000/muL (normal range 150,000-450,000/muL) (Figure 1C).
case_images: Echocardiogram from the initial emergency presentation, featuring views from the apical four-chamber and short-axis, displaying extensive pericardial fluid.
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case_images: Subsequent echocardiography disclosed a massive pericardial effusion, which led to a compressed right atrium (Figure 2).
case_images: Initial pericardiocentesis fluid aspiration revealing haemorrhagic content.
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case_images: Initially, the procedure removed 850 mL of haemorrhagic fluid (Figure 3).
case_images: Cytomorphology evaluation showing immature myeloid cells with erythroid forms (leucoerythroblastic) displaying evidence of haematopoietic progenitor cell activity.
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case_images: Cytomorphology evaluation of the fluid revealed the presence of nucleated red blood cells, neutrophil precursors, and immature myeloid cells with erythroid forms, indicating a leucoerythroblastic pattern and suggesting haematopoietic progenitor cell activity (Figure 4).
case_images: Echocardiogram during follow-up revealing signs indicative of constrictive pericarditis. (A and B) Tissue Doppler index (TDI) measurements demonstrating elevated E' in the medial aspect and reduced E' in the lateral aspect (annulus reversus). (C) Septal wall movement towards the left ventricle (LV) during inspiration and towards the right ventricle (RV) during the expiration phase, suggestive of further reduced LV filling during the inspiration phase (septal bounce/paradoxical septal movement). (D) Mitral inflow variation >25% with respiration, indicating significant fluctuations in mitral blood flow with breathing.
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case_images: A follow-up echocardiography examination demonstrated minimal pericardial effusion along with signs indicative of constrictive pericarditis, including paradoxical septal movement, increased mitral inflow variation >25%, and increased medial E' compared with lateral E' (annulus reversus) (Figure 5).