HPI

49yo F  c/o diffuse abd pain. Denies cp, sob +Nausea, no emesis No change in bowel habits

PMHx 

• hyperthyroidism s/p RAI w/ subsequent Hypothyroidism
• RCC s/p Nephrectomy (2008)
• bipolar disorder
• chronic anemia

Physical Exam

• BP 105/59 | Pulse 68 | Temp 98.6 °F (37 °C) (Oral) | Resp 16 | SpO2 96% | BMI 36.02 kg/m²
• Morbidly obese, appears uncomfortable and chronically ill and older than stated age
•  Lungs clear
• Abdomen ttp RLQ and midline/suprapubic BLE edema

Workup

• CT A/P showed no acute intra-abdominal pathology, but incidentally found to have pericardial effusion.

DDx for pericardial effusion

• Idiopathic
• malignant
• post-MI
• uremic
• autoimmune
• radiation
• infectious
• hypothyroidism
• tuberculosis

Management

• Upon evaluation with cardiac POCUS, noted to have early tamponade physiology
• Repeat BP was 87/50
• Seen by cardiology, who admitted patient to the cardiac ICU for serial echocardiograms and continuous monitoring of vitals
• Interventional cardiology decided to defer pericardiocentesis as pt was asymptomatic and effusion was posterior and difficult to access •
• Labs showed TSH 74.6; FT4 <.1

Take Home Points

• Remember hypothyroidism as a potential cause of pericardial effusion
• Don't forget your POCUS findings for pericardial tamponade: RV diastolic collapse, IVC dilation, hyperdynamic LV

References:

Chahine J, Ala CK, Gentry JL, et al. Pericardial diseases in patients with hypothyroidism Heart 2019;105:1027-1033.

Synovitz CK, Brown EJ. Pericardiocentesis. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.