Intrapericardial urokinase irrigation combined with systemic corticosteroids may be a viable alternative to pericardectomy for persistent fibrino-purulent pericarditis.
May avoid pericardectomy in select refractory cases; hypothesis-generating case report leaves efficacy and safety open for prospective study.
A 39-year-old man was admitted for upper abdominal pain and shortness of breath. The chest roentgenogram demonstrated cardiomegaly and left lower lobe atelectasis. Echocardiography showed circumferential pericardial effusion with signs of cardiac tamponade. Pericardial biopsy and fluid analysis were consistent with fibrino-purulent pericarditis. Despite broad-spectrum antibiotics, percutaneous and subsequently surgical drainage, pericardial effusion and tamponade recurred. We report successful treatment of a non-resolving fibrino-purulent pericardial effusion by combined intrapericardial irrigation of fibrinolytics and systemic corticosteroids administration as an alternative to pericardectomy.
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Markus Schäfer (2002) studied this question.
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