Purulent Pericarditis Following Endobronchial Biopsy of Lymph Node (4R)

Figures

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  Figure 1. Admission Electrocardiogram Showing Diffuse ST-Segment Elevations and PR Depressions With PR Elevation in aVR

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  Figure 2. Computed Tomography Pulmonary Angiogram Computed tomography thorax (A: axial view, B: coronal view) on admission showing no evidence of pulmonary embolism, distal airway mucous plugging/debris, or soft tissue density in the lower right paratracheal region, possibly reflecting complex fluid. New small volume pericardial effusion and thickening. No gas or necrosis to suggest mediastinitis.

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  Figure 3. Echocardiogram on Admission Admission formal echocardiogram revealed a small circumferential pericardial effusion, measuring up to 12 mm anterior to the right ventricle (asterisk).

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  Figure 4. Echocardiogram After 3 Days Repeat echocardiogram showing an increase in effusion to moderate, measuring up to 20 mm (asterisk), with development of fibrinous stranding (arrows).

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  Figure 5. Echocardiogram Showing Tricuspid Valve Inflow Velocity Variation With Respiration, Consistent With Constrictive Pathology

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  Figure 6. Tissue Doppler of the Mitral Valve Showing Evidence of Both Annulus Paradoxus (Septal e' >8 m/s) and Annulus Reversus (Septal e' > Lateral e'), Indicative of Pericardial Constriction

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  Figure 7. Echocardiographic Findings Immediately After Pericardiocentesis Showing Persistent Mitral Valve Inflow Velocity Variation With Respiration Consistent With Constrictive Pathology

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  Figure 8. Discharge Electrocardiogram Showing Resolution of Prior Diffuse ST-Segment Elevations and PR Depressions Persistent abnormality in the PR segment in aVR can still be noted.

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  Visual Summary. Purulent Pericarditis With Pericardial Effusion and Fibrinous Stranding Purulent pericarditis with pericardial effusion (asterisk) and fibrinous stranding (arrows).