An atypical case of purulent pericarditis and cardiac tamponade found on bedside echocardiography

Background

Bacterial pericarditis is a rare cause of pericardial disease, with purulent pericarditis making up less than 1 ​% of bacterial cases worldwide.

Case report

We report the case of a 52-year-old male with diabetes and end-stage renal disease on dialysis who presented for chest pain with an electrocardiogram concerning for myocardial ischemia. He was found to have a large pericardial effusion with heterogenous material and signs of sonographic tamponade on bedside ultrasound. His vital signs did not have any fever, tachycardia, or hypotension. His physical examination was negative for diminished heart sounds or jugular venous distension. He underwent a pericardiocentesis that grew staphylococcus aureus and was found to have a mediastinal abscess that required excision.

“Why should an emergency physician be aware of this?”

Bedside point-of-care transthoracic echocardiography can diagnose purulent pericarditis in the absence of clinical examination findings, electrocardiogram changes, or vital sign abnormalities.