From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case
Abstract Background Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thro...
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BMC
2025-01-01
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| Series: | International Journal of Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s12245-024-00794-z |
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| author | Amin Bagheri Morteza Sheikhi Nooshabadi Pouya Ebrahimi Roozbeh Nazari Pedram Ramezani Toktam Alirezaei |
| author_facet | Amin Bagheri Morteza Sheikhi Nooshabadi Pouya Ebrahimi Roozbeh Nazari Pedram Ramezani Toktam Alirezaei |
| author_sort | Amin Bagheri |
| collection | DOAJ |
| description | Abstract Background Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thromboembolism (VTE). Case Presentation An 83-year-old Iranian female was transferred to the emergency department of a tertiary cardiology hospital complaining of neck swelling concomitant with chest pain and dyspnea. The patient had been diagnosed with jugular vein thrombosis in another local center, and since the chief complaint was neck swelling, she underwent Doppler sonography, and the diagnosis was confirmed. Subsequently, the treatment with unfractionated heparin was started. After 5 h, considering the worsening of symptoms with the suspicious diagnosis of COVID-19 based on her symptoms and laboratory data, a chest computed tomography scan was requested, which showed a massive PE. Subsequently, transthoracic echocardiography confirmed the diagnosis. The patient was immediately transferred to the operating room and underwent pericardiotomy. The post-surgery period was uneventful, and she was discharged 5 days later. Conclusion Patients with viral infections, specifically COVID-19, are at risk of undiagnosed severe pericardial effusions. Venous stasis in the jugular veins due to PE can mimic jugular vein thromboembolism, causing a wrong diagnosis. Since treating thrombosis can exacerbate tamponade to hemodynamic instability and collapse, sufficient investigation before starting anticoagulants is necessary. Clinical key message Distinguishing VTE from PE is not always straightforward. Therefore, it is important to ensure physicians have reached an appropriate level of certainty about their diagnosis by performing precise diagnostics before using anticoagulants. Mismanagement with anti-thrombotics can result in catastrophic consequences. Therefore, taking an accurate history, performing a precise physical examination, and using rapid and available diagnostic modalities can avoid delays in definitive management. |
| format | Article |
| id | doaj-art-fb94c8cd1a9e4d85bf21db1cd580dcbb |
| institution | Kabale University |
| issn | 1865-1380 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj-art-fb94c8cd1a9e4d85bf21db1cd580dcbb2025-01-05T12:07:45ZengBMCInternational Journal of Emergency Medicine1865-13802025-01-011811910.1186/s12245-024-00794-zFrom thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis caseAmin Bagheri0Morteza Sheikhi Nooshabadi1Pouya Ebrahimi2Roozbeh Nazari3Pedram Ramezani4Toktam Alirezaei5Cardiovascular Research Center, Shahid Beheshti University of Medical SciencesCardiovascular Research Center, Shahid Beheshti University of Medical SciencesCardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical SciencesCardiovascular Research Center, Shahid Beheshti University of Medical SciencesFaculty of Medicine, Azad University of Medical SciencesMen’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical SciencesAbstract Background Anticoagulants increase the risk of cardiac tamponade in patients with pericardial effusion (PE). Therefore, inappropriate administration of them in the presence of PE can lead to a catastrophic outcome. This study presents a patient with a provisional misdiagnosis of venous thromboembolism (VTE). Case Presentation An 83-year-old Iranian female was transferred to the emergency department of a tertiary cardiology hospital complaining of neck swelling concomitant with chest pain and dyspnea. The patient had been diagnosed with jugular vein thrombosis in another local center, and since the chief complaint was neck swelling, she underwent Doppler sonography, and the diagnosis was confirmed. Subsequently, the treatment with unfractionated heparin was started. After 5 h, considering the worsening of symptoms with the suspicious diagnosis of COVID-19 based on her symptoms and laboratory data, a chest computed tomography scan was requested, which showed a massive PE. Subsequently, transthoracic echocardiography confirmed the diagnosis. The patient was immediately transferred to the operating room and underwent pericardiotomy. The post-surgery period was uneventful, and she was discharged 5 days later. Conclusion Patients with viral infections, specifically COVID-19, are at risk of undiagnosed severe pericardial effusions. Venous stasis in the jugular veins due to PE can mimic jugular vein thromboembolism, causing a wrong diagnosis. Since treating thrombosis can exacerbate tamponade to hemodynamic instability and collapse, sufficient investigation before starting anticoagulants is necessary. Clinical key message Distinguishing VTE from PE is not always straightforward. Therefore, it is important to ensure physicians have reached an appropriate level of certainty about their diagnosis by performing precise diagnostics before using anticoagulants. Mismanagement with anti-thrombotics can result in catastrophic consequences. Therefore, taking an accurate history, performing a precise physical examination, and using rapid and available diagnostic modalities can avoid delays in definitive management.https://doi.org/10.1186/s12245-024-00794-zPericardial effusionTamponadeThromboembolismMisdiagnosisCase report |
| spellingShingle | Amin Bagheri Morteza Sheikhi Nooshabadi Pouya Ebrahimi Roozbeh Nazari Pedram Ramezani Toktam Alirezaei From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case International Journal of Emergency Medicine Pericardial effusion Tamponade Thromboembolism Misdiagnosis Case report |
| title | From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case |
| title_full | From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case |
| title_fullStr | From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case |
| title_full_unstemmed | From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case |
| title_short | From thrombosis to tamponade: unveiling severe pericardial effusion in a misdiagnosis case |
| title_sort | from thrombosis to tamponade unveiling severe pericardial effusion in a misdiagnosis case |
| topic | Pericardial effusion Tamponade Thromboembolism Misdiagnosis Case report |
| url | https://doi.org/10.1186/s12245-024-00794-z |
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