Critical Cases - Pericardial effusion!


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


  • 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



  • 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



  • 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










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.