Key result
Serial pericardiocentesis safely evacuates ~13,000 mL of fluid over two years in recurrent massive effusion.
Why the study?
Massive recurrent pericardial effusion poses a diagnostic and therapeutic challenge when the etiology remains unclear despite repeated drainage.
Case Report (n=1)
No
This case illustrates that chronic pericardial distension can allow patients to hemodynamically tolerate extreme fluid volumes (up to 3,800 mL in a single drainage and 13,000 mL total) requiring repeated pericardiocenteses, while highlighting the diagnostic complexity of excluding malignancy when cytology remains negative after tumor resection.
Answers are grounded in this paper and cite their sources.
Chronic distension may permit hemodynamic tolerance of recurrent massive effusions via repeated drainage in elderly patients; leaves open etiology and prevention after negative cytology.
Massive recurrent pericardial effusion is a diagnostic and therapeutic challenge, particularly when the etiology remains unclear despite repeated drainage. An 83-year-old man with pericarditis since 2007 and pericardial effusion documented in 2018 was hospitalized in 2024 with massive pericardial and bilateral pleural effusions. A renal tumor was identified and treated by radical nephrectomy. Despite anti-inflammatory therapy, the pericardial effusion repeatedly reaccumulated. Four pericardiocenteses between 2024 and 2026 evacuated approximately 13.000 mL of fluid, with a maximum single drainage of 3.800 mL. At least two episodes showed echocardiographic and hemodynamic signs of impending cardiac tamponade. Microbiological studies and repeated cytological examinations were negative. This case demonstrates extreme chronic pericardial fluid accumulation requiring repeated therapeutic pericardiocentesis. The long history preceding renal tumor diagnosis, continued recurrence after nephrectomy, and negative cytological and microbiological findings favor an undetermined etiology, although malignancy remained an important unproven differential diagnosis.
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Akinola et al. (2026) conducted a case report in Recurrent massive pericardial effusion with impending cardiac tamponade (n=1). Repeated pericardiocentesis and anti-inflammatory therapy (NSAIDs, colchicine, corticosteroids) was evaluated on Total volume of evacuated pericardial fluid across four pericardiocentesis procedures. Four repeated pericardiocenteses evacuated approximately 13,000 mL of fluid (up to 3,800 mL in a single drainage) over two years in an 83-year-old man with recurrent massive pericardial effusion.
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