Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics

Stuck pericardial pigtail catheter in purulent pericarditis: early surgery?

Pyopericardium is rare in the modern antibiotic era but is still infrequently seen in the setting of immunosuppression, recent thoracic surgery and sepsis. Although classically an extension of a thoracic gram-positive bacterial infection, gram-negative bacterial purulent pericarditis may be encountered in the setting of nosocomial infections. Emergent pericardial drainage allows for prompt definitive management and planning for further intervention. Early surgery should be the priority after a failed retrieval of the catheter. Appropriate surgical methods should be employed to minimize complications associated with stuck catheters. We report a case of pyopericardium secondary to a clinically silent lung abscess in an immunocompetent 49-year-old patient. This was treated by standard pericardial drainage via a pigtail catheter. Multiple failed attempts in removal warranted a surgical approach to remove the coiled catheter. The catheter was found to be coiled around the heart with presence of clots in the pericardium.

Two-dimensional transthoracic echocardiographic demonstration of reduction in fibrin content in purulent pericarditis following intrapericardial fibrinolytic agent administration

We describe an adult patient who presented with purulent pericarditis (PP) in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular (RV) wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images has not been reported previously in an adult patient with PP, to the best of our knowledge.