What is the clinical evidence from this study?

Study design: Case Report. Population: Purulent pericarditis with mixed obstructive and distributive shock (n=1). Intervention: Pericardiocentesis. Primary outcome: Hemodynamic improvement (Right atrial pressure and cardiac index).

What does this research mean for the field?

Pericardiocentesis effectively improves hemodynamics, specifically right atrial pressures and cardiac index, in patients presenting with mixed obstructive and distributive shock due to MSSA purulent pericarditis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This case report aims to illustrate the rare occurrence of purulent pericarditis causing mixed obstructive and distributive shock.

May 20, 2026

B49-27 Purulent Pericarditis - A Rare Etiology of Mixed Obstructive and Distributive Shock

Key Result

Pericardiocentesis draining 690cc of purulent fluid in a patient with MSSA purulent pericarditis improved right atrial pressures from 18 to 8 mmHg and cardiac index from 1.8 to 2.3 L/min/m2.

Key Points

This case report aims to illustrate the rare occurrence of purulent pericarditis causing mixed obstructive and distributive shock.
Presented a case of a 73-year-old male with a series of diagnostic tests including TTE and POCUS.
Conducted right heart catheterization and pericardiocentesis to manage the patient's condition.
Monitored hemodynamic changes and laboratory results throughout hospitalization.
The patient developed obstructive shock with confirmed cardiac tamponade and required ICU transfer.
Successful pericardiocentesis drained 690cc of purulent pericardial fluid, improving RA pressures from 18 mmHg to 8 mmHg.
Blood and pericardial fluid cultures tested positive for MSSA, with imaging confirming a myocardial abscess.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 patient, 73-year-old male with no prior medical history, presenting with MSSA purulent pericarditis, obstructive shock, and distributive shock.

Intervention

Pericardiocentesis (drained 690cc of purulent fluid) and transfer for definitive surgical management

Purulent pericarditis is a rare but life-threatening condition that can cause mixed obstructive and distributive shock, where early diagnosis with POCUS and prompt pericardiocentesis are critical for hemodynamic stabilization.

Abstract

Abstract Introduction Purulent pericarditis resulting in obstructive shock (cardiac tamponade) and distributive shock is a rare, life-threatening condition. This case highlights a patient who developed obstructive shock and myocardial abscess in the setting of methicillin sensitive Staphylococcus aureus (MSSA) purulent pericarditis. Case Presentation A 73-year-old male with no prior medical history and limited interaction with the healthcare system presented to the emergency department with constipation, weakness, and fatigue. He was found to have new onset atrial fibrillation with RVR, evidence of prior anterior STEMI on EKG, and acute kidney injury (AKI). Initial TTE showed reduced ejection fraction of 29%, an LV apical aneurysm with thrombus, and a moderate pericardial effusion. He was started on a heparin drip. During hospitalization, he developed signs of shock with hypotension requiring levophed, elevated lactate, transaminitis, and anuria. He was transferred to the ICU where POCUS showed signs of cardiac tamponade including worsening effusion, dilated IVC and RV diastolic collapse. This was confirmed by repeat TTE showing increased respiratory variation in transmitral and transtricuspid flow velocities confirming tamponade. The patient underwent right heart cath showing elevated RA pressures of 18 mmHg and CI 1.8 L/min/m2. Interventional cardiology performed a pericardiocentesis and drained 690cc of purulent pericardial fluid. After drainage, RA pressures improved to 8 mmHg and CI to 2.3 L/min/m2. Blood and pericardial fluid cultures returned positive for MSSA. A contrasted CT scan of the chest showed the pericardial effusion with loculations and a collection at LV apex consistent with myocardial abscess. Patient was transferred to a quaternary hospital with cardiothoracic surgery for definitive surgical management. Discussion Purulent pericarditis constitutes less than 1% of all pericarditis cases. Such patients can develop both obstructive shock due to cardiac tamponade and distributive (septic) shock from bacteremia, purulent myocardial abscesses and infected cardiac thrombi. POCUS is an essential tool to help make early diagnosis. This abstract is funded by: None

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Cite This Study

Carlson et al. (Fri,) conducted a case report in Purulent pericarditis with mixed obstructive and distributive shock (n=1). Pericardiocentesis was evaluated on Hemodynamic improvement (Right atrial pressure and cardiac index). Pericardiocentesis draining 690cc of purulent fluid in a patient with MSSA purulent pericarditis improved right atrial pressures from 18 to 8 mmHg and cardiac index from 1.8 to 2.3 L/min/m2.

synapsesocial.com/papers/6a0d4fecf03e14405aa9b59a https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.1382

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