Acute Polyserositis with Cardiac Tamponade and Bilateral Refractory Pleural Effusion after ChAdOx1 nCoV-19 Vaccination

Figures

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  Figure 1. Acute polyserositis with cardiac tamponade and bilateral refractory pleural effusion after ChAdOx1 nCoV-19 vaccination. (A) Chest X-ray shows the typical water bottle sign, which refers to the shape of the cardiac silhouette in patients who have a large pericardial effusion. The fluid causes the pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench. (B) Computed tomography reveals the presence of massive pericardial effusion (arrowheads) and bilateral pleural effusion (arrows). (C) A 12-lead electrocardiogram shows sinus rhythm with low QRS voltage, suggesting massive pericardial effusion.

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  Figure 2. Transthoracic echocardiography captured on the 45th day during hospitalization. The subcostal view shows a small amount of pericardial effusion and massive refractory pleural effusion bilaterally. LPE = left pleural effusion; RPE = right pleural effusion.

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  Figure 3. Microscopic view of the pleural specimen. Hematoxylin and eosin-stained pleural tissue by surgical biopsy shows focal lymphocytic infiltration, but without the presence of malignancy, granuloma, or lupus erythematosus cells. Original magnification 20×.

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  Figure 4. Repeated image studies during follow-up at the outpatient clinic. Chest X-ray (A) and the subcostal view of transthoracic echocardiography (B). Both show no recurrence of the effusion.