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Peer-reviewedCC BY-NC 4.0Journal of Investigative Medicine High Impact Case Reports

Pericardial Decompression Syndrome after Drainage of Malignant Pericardial Effusion: A Case Report

  • Mohamed Elhussain1
  • Muhammad Bilal2
  • Mazen Ahmed3
  • Mustafa Marzoug1
  • Ali Mohamedshata3
  • Esra Abdalla4
  • Shaun Cardozo2
  • Luis Afonso2
4 affiliations
  1. 1Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
  2. 2Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, MI, USA
  3. 3Department of Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, MI, USA
  4. 4Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
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Abstract

Pericardial decompression syndrome (PDS) is an uncommon but potentially fatal complication that can follow technically successful drainage of a hemodynamically significant pericardial effusion. A 61-year-old woman with stage IVB lung adenocarcinoma presented with progressive dyspnea and edema. Computed tomography and transthoracic echocardiography demonstrated a large pericardial effusion with right ventricular diastolic collapse and preserved left ventricular ejection fraction (LVEF) of 65% to 70%. Emergent echo-guided pericardiocentesis removed 360 to 380 mL of serosanguineous fluid, followed by catheter drainage totaling approximately 1.51 L. The next morning, echocardiography showed new severe biventricular systolic dysfunction with basal sparing and only trivial residual effusion. High-sensitivity troponin remained 10 ng/L or less without a meaningful rise. The clinical course was managed supportively with close hemodynamic and echocardiographic surveillance, cautious diuresis, and low-dose guideline-directed therapy as tolerated. LVEF improved from a nadir of 15% to 20% to 50% to 55% at follow-up, with resolution of the wall-motion abnormality and no recurrent effusion. The temporal association with large-volume drainage, absence of recurrent pericardial constraint, low troponin, and reversible dysfunction supported PDS. New heart failure after malignant pericardial effusion drainage should prompt urgent evaluation for PDS.

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Cite

BibTeXRIS
BibTeX
@article{elhussain2026pericardial,
  title = {{Pericardial Decompression Syndrome after Drainage of Malignant Pericardial Effusion: A Case Report}},
  author = {Mohamed Elhussain and Muhammad Bilal and Mazen Ahmed and Mustafa Marzoug and Ali Mohamedshata and Esra Abdalla and Shaun Cardozo and Luis Afonso},
  journal = {Journal of Investigative Medicine High Impact Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1177/23247096261491198},
  url = {https://doi.org/10.1177/23247096261491198},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Pericardial Decompression Syndrome after Drainage of Malignant Pericardial Effusion: A Case Report
AU  - Mohamed Elhussain
AU  - Muhammad Bilal
AU  - Mazen Ahmed
AU  - Mustafa Marzoug
AU  - Ali Mohamedshata
AU  - Esra Abdalla
AU  - Shaun Cardozo
AU  - Luis Afonso
PY  - 2026
DA  - 2026/09/16
JO  - Journal of Investigative Medicine High Impact Case Reports
DO  - 10.1177/23247096261491198
UR  - https://doi.org/10.1177/23247096261491198
AB  - Pericardial decompression syndrome (PDS) is an uncommon but potentially fatal complication that can follow technically successful drainage of a hemodynamically significant pericardial effusion. A 61-year-old woman with stage IVB lung adenocarcinoma presented with progressive dyspnea and edema. Computed tomography and transthoracic echocardiography demonstrated a large pericardial effusion with right ventricular diastolic collapse and preserved left ventricular ejection fraction (LVEF) of 65% to 70%. Emergent echo-guided pericardiocentesis removed 360 to 380 mL of serosanguineous fluid, followed by catheter drainage totaling approximately 1.51 L. The next morning, echocardiography showed new severe biventricular systolic dysfunction with basal sparing and only trivial residual effusion. High-sensitivity troponin remained 10 ng/L or less without a meaningful rise. The clinical course was managed supportively with close hemodynamic and echocardiographic surveillance, cautious diuresis, and low-dose guideline-directed therapy as tolerated. LVEF improved from a nadir of 15% to 20% to 50% to 55% at follow-up, with resolution of the wall-motion abnormality and no recurrent effusion. The temporal association with large-volume drainage, absence of recurrent pericardial constraint, low troponin, and reversible dysfunction supported PDS. New heart failure after malignant pericardial effusion drainage should prompt urgent evaluation for PDS.
SN  - 2324-7096
ER  -