Key result
Slower drainage during large-volume pericardiocentesis linked to lower pericardial decompression syndrome risk in systemic sclerosis.
Why the study?
Pericardial decompression syndrome is a rare and underrecognized complication of pericardiocentesis, especially in patients with chronic effusions and myocardial disease such as systemic sclerosis.
Case Report (n=1)
Postpericardiocentesis hemodynamic deterioration should prompt consideration of pericardial decompression syndrome rather than reflexive repeat drainage, suggesting slower or staged drainage may be safer.
Should raise suspicion for pericardial decompression syndrome with post-pericardiocentesis deterioration in systemic sclerosis; hypothesis-generating for staged drainage and requires prospective validation.
BACKGROUND: Pericardial decompression syndrome (PDS) is a rare and underrecognized complication of pericardiocentesis, characterized by paradoxical hemodynamic deterioration after relief of pericardial effusion. CASE SUMMARY: A 32-year-old woman with systemic sclerosis presented with chest pain and was found to have a large pericardial effusion with early tamponade physiology. She underwent rapid, large-volume pericardiocentesis. Hours later, she developed acute respiratory failure and cardiac arrest. Repeat echocardiography demonstrated new severe left ventricular systolic dysfunction without recurrent effusion, consistent with PDS. Misinterpretation as recurrent tamponade led to emergent repeat pericardiocentesis complicated by right ventricular perforation requiring surgical repair. Ventricular function fully recovered with supportive care. DISCUSSION: PDS is infrequently recognized and may be precipitated by rapid drainage in patients with chronic effusions and underlying myocardial disease, such as systemic sclerosis. TAKE-HOME MESSAGES: Postpericardiocentesis deterioration should prompt consideration of PDS rather than reflexive repeat drainage. Slower or staged pericardial drainage may reduce the risk of catastrophic complications.
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Mubaid et al. (2026) conducted a case report in Systemic sclerosis with large pericardial effusion (n=1). Rapid, large-volume pericardiocentesis was evaluated on Pericardial decompression syndrome. Rapid, large-volume pericardiocentesis in a 32-year-old woman with systemic sclerosis resulted in pericardial decompression syndrome, acute respiratory failure, and cardiac arrest.
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