ACUTE CARDIAC TAMPONADE IN HYPOTHYROIDISM: ROLE OF INTERVENTIONAL ULTRASOUND IN THE DIAGNOSIS AND TREATMENT

Purpose: We present a rare case of acute cardiac tamponade in a Hypothyroid patient treated with percutaneous drainage under US guidance. We report the Rx and US findings and stress the role of interventional US as fundamental tool in emergency.

Methods and Materials: Case report: female, 58 years with Down syndrome, presented at the emergency Department of our Institution with severe dyspnea, shock, abdominal pain. Chest X-ray showed cardiac enlargement and pleural effusion. Abdominal ultrasound (US) examination showed mild ascites, normal abdominal organs, bilateral pleural effusion and a “small“ heart in a massive pericardial effusion. The patient underwent pericardial drainage in general anesthesia with 8 French pig-tail catheter positioned with Seldinger technique under US guidance.

Results: 480ml of clear watery fluid was drained and immediately afterwards the patient recovered. The catheter was left in situ for 6 days and withdrawn when the daily drained fluid was <10ml. Examination of pericardial fluid did not show inflammation. Except for mild increase of serum creatinine levels, routine laboratory tests were within normal ranges. Serological tests for many of the common viral infections were all negative. Thyroid hormones dosage showed severe hypothyroidism (TSH=175 mlU/L). L-Tiroxine therapy determined a fast and progressive improvement of patient's conditions. No relapse have been observed during a 6 months follow-up.

Conclusions: emergency Interventional US is a fast and decisive tool for the diagnosis and treatment of acute cardiac tamponade. The diagnosis of hypothyroidism should be considered in patients presenting with unexplained pericardial effusion tamponade