Key result
Pericardial drainage resolves severe right upper quadrant pain and normalizes liver enzymes in cardiac tamponade.
Why the study?
Pericardial effusion presenting with isolated abdominal pain and no cardiopulmonary symptoms is rare and closely mimics acute hepatobiliary pathology, creating a risk of unrecognised progression to life-threatening cardiac tamponade.
Case Report (n=1)
No
This case demonstrates that large pericardial effusions can present solely with right upper quadrant pain and deranged liver enzymes due to congestive hepatopathy, closely mimicking acute hepatobiliary disease in the absence of classic cardiac symptoms.
May warrant considering pericardial effusion in unexplained RUQ pain with elevated AST; extends recognized presentations but remains hypothesis-generating from one case.
Background Pericardial effusion typically presents with chest pain, dyspnoea, and positional discomfort. Presentation with isolated abdominal pain in the absence of cardiopulmonary symptoms is rare and closely mimics acute hepatobiliary pathology. Recognition is critical, since unrecognised pericardial effusion may progress to life-threatening cardiac tamponade. Case Presentation A 43-year-old black African woman with virologically suppressed human immunodeficiency virus infection (HIV), ulcerative colitis, and a history of previously treated latent tuberculosis (TB) infection presented to the emergency department with a one-day history of abdominal pain radiating to the flanks and epigastrium. Right upper quadrant tenderness on examination and elevated liver enzymes upon further investigation prompted a provisional diagnosis of cholecystitis. A subsequent chest radiograph showed a globular cardiac silhouette and bedside echocardiography confirmed a large pericardial effusion. Computed tomography (CT) demonstrated an effusion with features of right cardiac impairment, hepatic congestion and pericholecystic fluid, with no evidence of acute cholecystitis. Pericardiocentesis yielded haemoserous fluid, with resolution of symptoms and improvement in liver enzymes. The effusion re-accumulated within 5 days, with right ventricular diastolic collapse and this was surgically managed. The rapid recurrence raised suspicion of a potential inflammatory aetiology; however, the definitive aetiology remains unclear. Conclusions Pericardial effusion should be considered in patients with undifferentiated abdominal pain and liver enzyme derangement, even in the absence of typical cardiac symptoms or Beck’s triad. This case highlights the potential for cardiac pathology to mimic acute hepatobiliary disease and emphasises the importance of maintaining a broad differential diagnosis in atypical abdominal presentations.
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Jha et al. (2026) conducted a case report in Pericardial effusion and cardiac tamponade presenting as isolated right upper quadrant pain with congestive hepatopathy (n=1). Pericardiocentesis followed by subxiphoid pericardial window was evaluated on Resolution of abdominal pain, liver enzyme improvement, and resolution of recurrent pericardial effusion. Pericardiocentesis (300 mL) and a subxiphoid pericardial window (700 mL) resolved right upper quadrant pain and reduced AST from 189 to 61 U/L in a patient with large pericardial effusion.
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