Photo Credit: Moesy

The following is a summary of “Emergent Pericardial Window in a Patient with Sarcoidosis-like Interstitial Lung Disease, COPD, and MGUS Presenting with Syncope and Chronic Pericardial Effusion,” published in the October 2024 issue of Pulmonology by Shoar et al. 

Cardiac sarcoidosis can cause heart rhythm problems, but severe pericardial effusion leading to fainting and acellular fluid analysis has not been documented. 

 Researchers conducted a case study investigating massive acellular pericardial effusion in a patient with sarcoidosis presenting with syncope.  

The case involved a 65-year-old male who had a medical history that included chronic obstructive pulmonary disease (COPD), interstitial lung disease resembling sarcoidosis, and moderate chronic pericardial effusion alongside monoclonal gammopathy of undetermined significance. He arrived at the emergency department after experiencing a brief syncopal episode and had worked in construction for most of his life, exposing him to cement dust. 

Although he quit smoking tobacco a few years earlier, and did not have regular follow-up appointments due to lack of insurance and had not been on any medications. Initial imaging indicated an enlarged cardiac silhouette, while follow-up echocardiography showed a massive pericardial effusion and severe pulmonary hypertension, with an estimated right ventricular systolic pressure (RVSP) of 134.3 mmHg. 

In discussion, a pericardial window was performed the following day, draining 1.4 liters of serous fluid. Cytology, culture, and chemistry of the fluid showed no significant findings. Tissue biopsy was negative for malignancy and granulomatous reactions. An immunological panel revealed positive results for antinuclear antibody (ANA) with a speckled pattern (titer: 1:80), anti-Ro/SSA antibody, and elevated angiotensin-converting enzyme (ACE) at 101 (normal range < 80). The postoperative course was uncomplicated, and the drainage catheter was removed on day 6. A follow-up echocardiogram confirmed the resolution of the effusion. 

They concluded a massive acellular pericardial effusion in patients with sarcoidosis can be challenging to manage due to uncertainty in origin, often requiring surgical drainage to address hemodynamic instability. 

Source: journal.chestnet.org/article/S0012-3692(24)02721-1/fulltext