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Massive pericardial effusion with left-to-right intracardiac shunt

Published online by Cambridge University Press:  15 August 2006

A. J. Edwards
Affiliation:
Department of Radiology, Derriford Hospital, Plymouth, United Kingdom
N. J. Ring
Affiliation:
Department of Radiology, Derriford Hospital, Plymouth, United Kingdom
A. J. Marshall
Affiliation:
Department of Cardiology, Derriford Hospital, Plymouth, United Kingdom

Abstract

We describe a 31-year-old man with Down's syndrome who presented with severe chronic hypothyroidism and a massive pericardial effusion. Following partial aspiration of this effusion, he rapidly deteriorated and died. Findings at autopsy revealed him to have an atrioventricular septal defect with shunting at the atrial level. We postulate that, by releasing extrinsic pressure on his right heart by the aspiration, there was sudden shunting of blood from left-to-right, resulting in hypotension, shock, and subsequent death. We highlight the difficulties in management of such a case, and suggest alternative strategies.

Type
Brief Report
Copyright
2001 Cambridge University Press

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