Key result
Pericardial fenestration can fail via loculated effusion recurrence that evades standard chest radiography.
Case Report (n=1)
Localized reaccumulation of pericardial effusion can occur after fenestration due to adhesions and may be radiographically occult on standard frontal chest radiography, necessitating multimodal imaging such as echocardiography and CT.
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Chest X-ray may miss heterogeneous reaccumulation after fenestration; leaves open optimal surveillance in malignant tamponade.
A 70-year-old man with advanced lung adenocarcinoma visited our hospital complaining of dyspnea. He was diagnosed with cardiac tamponade and underwent pericardial drainage. Pericardial effusion reaccumulated in 73 days, and right pericardial fenestration was performed. Although his respiratory condition worsened three weeks after the surgery, his chest X-ray showed little change. He died of respiratory failure the next day. Autopsy CT revealed heterogeneously reaccumulated pericardial effusion in the pericardial cavity, which was difficult to detect by frontal chest X-ray. An autopsy revealed adhesions around the fenestration site. Pericardial effusion may heterogeneously reaccumulate in the pericardial cavity due to adhesions. When the respiratory condition worsens even after fenestration for cardiac tamponade, lateral imaging, echocardiography, and chest CT should also be considered.
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Kobayashi et al. (2025) conducted a case report in Cardiac tamponade and malignant pericardial effusion (n=1). Pericardial fenestration was evaluated. Localized reaccumulation of pericardial effusion can occur after pericardial fenestration due to adhesions and may be undetectable on standard frontal chest radiography, requiring multimodal imaging.
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