Cause Of Pericardial Effusion Research Articles

The immunopathogenesis of tuberculous pericarditis

Tuberculous pericarditis is a severe form of extrapulmonary tuberculosis and is the commonest cause of pericardial effusion in high incidence settings. Mortality ranges between 8 and 34%, and it is the leading cause of pericardial constriction in Africa and Asia. Current understanding of the disease is based on models derived from studies performed in the 1940–50s. This review summarises recent advances in the histology, microbiology and immunology of tuberculous pericarditis, with special focus on the effect of Human Immunodeficiency Virus (HIV) and the determinants of constriction.

Etiology of Pericardial Effusion and Outcomes Post Pericardiocentesis in the Western Region of Saudi Arabia: A Single-center Experience.

BackgroundPericardial effusion is the accumulation of blood or excess fluid in the cavity between the heart and the pericardium sac. Pericardial effusion can be caused by several etiologies, including malignant and non-malignant causes. Pericardiocentesis is the gold standard assessment method for pericardial effusion etiology. The aim of this study was to identify the long-term outcome of patients who presented with massive pericardial effusion and underwent pericardiocentesis at King Abdulaziz Medical City, Jeddah, a large tertiary hospital in the western part of Saudi Arabia.MethodsThis is a single-center retrospective cross-sectional study conducted at King Abdulaziz Medical City Jeddah, Saudi Arabia, between January 2013 to December 2018. Data were collected from patient’s charts; the clinical and echocardiographic findings, alongside with pericardial fluid analysis, were collected. Procedure and patients outcomes were obtained and reported.ResultsOf the 107 patients with pericardial effusion, 39 patients had moderate to severe pericardial effusion requiring pericardiocentesis. The mean age was 52 years, and 56.4% were females. The most common chronic disease was hypertension and the presence of metastasis. The most common cause of pericardial effusion was a malignancy. A majority of patients had severe pericardial effusion. Many patients had tamponade (69.6%). Patients with malignant pericardial effusion had a median survival of 54 days.ConclusionEtiologies of pericardial effusion requiring drainage depend on the population studied. Patients with malignant effusions have worse outcomes than non-malignant effusion. Pericardiocentesis is required to ascertain the cause and risk-stratify patients.

Intra-hospital prognosis of pericardial diseases in tropical area: Single-Center Study in Central Africa

Pericardial diseases (PD) are varied in tropical area, and the major causes are infections. To determine the frequency and the main diseases of pericardium. This cross-sectional study was conducted from January 2008 to December 2017 in the department of cardiology at University Hospital of Brazzaville. We had included, the patients admitted for PD. A total of 113 patients, 62 men (55%) were included. The frequency of PD was 2.3%. The mean age was 35.7 ± 15.5 years. Patients aged < 44 years ago were most represented ( n = 87, 77%). The medical history were: hypertension ( n = 16, 14.2%), tuberculosis ( n = 14, 12.4%) and HIV ( n = 9, 8%). The reasons for hospitalization were: dyspnea (79.6%), chest pain (58.4%) and cough (53.1%). In examination, the signs were: tachycardia ( n = 71, 62.8%), fever ( n = 63, 55.8%), hepatomegaly ( n = 53, 46.9%). The chest X-ray showed cardiomegaly ( n = 104, 92%). Echocardiography revealed pericardial effusion ( n = 79, 70%). In blood tests, inflammation (n = 91, 80.5%) and anemia ( n = 61, 54%) were reported. The PD were: pericardial effusion ( n = 104, 92%), constrictive pericarditis ( n = 7) and dry pericarditis ( n = 2). The causes of pericardial effusions were tuberculosis ( n = 77, 74%), bacterial infection (n = 10, 8.8%) and chronic renal failure ( n = 6, 5.3%). Tuberculosis-HIV co-infection was noted in 17.7%. The treatment used: anti-tuberculosis ( n = 77, 74%), steroids ( n = 54, 47.8%), antalgics ( n = 36, 32%), colchicine ( n = 12). Tamponade and death was recorded in 8 cases (7.1%) respectively. Tamponade was the only independent factor of death (OR 13.8, 95% CI 2.24–82, P = 0.003) in logistic regression analysis. Tuberculosis is the most cause of pericardial effusion in our environment. In view of these results, early detection and effective management of tuberculosis must remain an essential part of the national program to fight this disease. Tuberculosis remains a public health problem in our country.

SUN-551 Massive Pericardial Effusion Complicating Systemic Lupus Erythematosus and Autoimmune Hypothyroidism: A Case Report

Background: The presence of autoantibodies is a mutual ground for Systemic Lupus Erythematosus (SLE) and Autoimmune Hypothyroidism (AH). Pericardial effusion (PEEF) is a common manifestation for each disease condition however massive PEEF especially with tamponade is a rare occurrence. The coexistence of SLE and AH causing massive PEEF is even rarer and only few cases have been reported. This presents as a diagnostic dilemma whether the massive PEEF is primarily driven by SLE, AH or is it a synergistic effect of both. Clinical Case: A case of a 54-year-old female, hypertensive, non-diabetic diagnosed previously with primary hypothyroidism came in with progressive dyspnea. She has been non-compliant to levothyroxine therapy for 1 year. Upon presentation at the Emergency Department, she was noted to be overtly hypothyroid. Thyroid panel was consistent with primary AH: elevated TSH = 95.66 uIU/mL (NV=0.35-4.94), low FT3 = <1 pg/mL (NV=1.71-3.71), low FT4 = <0.4 ng/dL (NV=0.7-1.48) and elevated anti-TPO = 770.9 IU/mL (NV=<9.0). Ultrasound of the thyroid showed non-uniform echopattern. Pertinent physical findings were an elevated JVP and muffled heart sounds but with stable blood pressure. A 2-dimensional echocardiogram (2D-Echo) confirmed the presence of massive PEEF with doppler evidence of beginning tamponade. Other laboratory findings were anemia, leukopenia, albuminuria and high creatinine level. With this unusual clinical presentation, SLE as a secondary cause of PEEF was entertained. ANA at 1:320 with speckled pattern as well as anti-dsDNA at 516.25 IU/ml (NV=<0-200) were both positive with low complement factor 3 level (C3) = 0.89 g/L (NV=0.9-1.8) fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) criteria for SLE. The patient was given levothyroxine and prednisone for primary hypothyroidism and SLE, respectively. There was then gradual improvement of symptoms with a decrease in the PEEF on repeat 2D-Echo. She was noted to be clinically stable on subsequent follow-ups with further resolution of the massive PEEF. Conclusion: This was a rare case of SLE and AH causing massive PEEF with beginning tamponade which was successfully managed medically. This gave us valuable insight that massive PEEF occurring in hypothyroidism may be secondarily caused by other co-existing disease entities. Although it remained to be a diagnostic dilemma whether the massive PEEF was primarily because of SLE or AH or an effect of both, this case offered another opportunity to further explore the relationship of AH and connective tissue diseases such as SLE.

MORE THAN WHAT MEETS THE EYE: A NOT SO OBVIOUS CAUSE OF PERICARDIAL EFFUSION

Cytomegalovirus (CMV) infection is a rare cause of pericardial effusion in adults. Viral serology is not thought to be helpful in evaluation of viral pericardial effusion. A 59-year-old Ethiopian female with history of diffuse cutaneous systemic sclerosis and Sjogren's syndrome on chronic

Pericardial injury with cardiac tamponade and bleeding from the pericardium confirmed using contrast-enhanced computed tomography: a case report

BackgroundSimple pericardial injuries are asymptomatic in many cases and usually do not cause bleeding that leads to cardiac tamponade. In this study, however, we report a case involving a patient with pericardial injury, in whom extravasation in the pericardium was identified using contrast-enhanced computed tomography (CT).Case presentationA 67-year-old man fell from a 3-m-high ladder and was injured and transported to our hospital. No pericardial effusion was observed on focused assessment with sonography for trauma (FAST) or plain CT on arrival, but pericardial effusion was detected on follow-up observation. Thereafter, his circulatory dynamics began to deteriorate. We then performed FAST to identify the bleeding source, but it was difficult to visualize on echocardiography. Thus, contrast-enhanced CT (CECT) was performed and extravasation was confirmed in the pericardium. We believed that the accumulation of pericardial effusion caused cardiac tamponade; hence, we performed emergent thoracotomy. When we released the cardiac tamponade, his circulatory dynamics improved, and we could stabilize the patient’s condition by ligating the bleeding vessel from the pericardium.ConclusionIf visualization is difficult on FAST, like in this case, CECT is useful for identifying the cause of pericardial effusion if circulatory dynamics can be determined. We were able to confirm that extravasation occurred from the pericardium using CECT; hence, we could confirm that pericardial injury caused bleeding and may cause cardiac tamponade. Thus, if cardiac tamponade is suspected, not only damage to the heart itself, but also damage caused by pericardial vascular injury should be considered. Further, if circulatory dynamics are stable, CECT should be performed.

Study of Etiological Profile, Clinical Profile and Short Term Outcome of Patients Presenting with Pericardial Effusion in a Tertiary Care Center, Nepal

Introduction: Pericardial effusion is one of the common cardiac problems in our part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality. Our objective of the study was to determine the etiological spectrum of pericardial effusion, their clinical presentations and complications and assessing the usefulness of echocardiographic features of effusion in helping to determine the etiology. Methods: A cross-sectional observational prospective study of 63 patients with diagnosis of pericardial effusion was enrolled in the study. Pericardial effusion was diagnosed by echocardiography and pericardiocentesis was done in the cardiac catheterization room. Patients were followed up 3 monthly for 1 year and reassessed clinically and by echocardiography. Results: Patients presenting with pericardial effusion belonged to the age group of 8 to 88 years. The most common etiology was tuberculosis (36.5%) followed by malignancy (19%) and idiopathic/Viral (12.6%). Among malignancies, carcinoma lung was the most common cause followed by lymphoma. Pericardiocentesis was done in 46 patients (73%) and the approach was subxiphoid. The procedure-related complications were in 4 patients (6.3%) and there was no death as a consequence of the procedure. The total mortality was 12 (19%) with in-hospital death of 6 patients (9.5%). Conclusions: The study showed tuberculosis as the most common cause of pericardial effusion in developing countries like Nepal and as a cause of cardiac tamponade in contrast to the studies from the developed world where malignancy remains the leading cause.

Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography- or Echocardiography - Guided Percutaneous Catheter Drainage Methods.

ObjectiveIn this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University.MethodsIn order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage.ResultsIn the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively.ConclusionCurrently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Safety and Outcome of Percutaneous Drainage of Pericardial Effusions in Patients with Cancer

Malignancy is a common cause of pericardial effusions. The findings, immediate safety and longer-term outcomes of pericardiocentesis are less well defined. We reviewed the cases of all patients with malignancy that underwent pericardiocentesis at our institution over a 10-year period. From January 1, 2007 to December 31, 2016, 171 patients with cancer underwent echo-guided pericardiocentesis. A total of 53% were male with a mean age of 60 ± 15 years. The average volume drained was 485 (IQR 350 to 719) ml. The procedure was technically successful in 170/171 (99.4%) of patients without significant complications; there were no procedure-related deaths. A total of 20% had hemorrhagic, 48% had serosanguinous, and 31% serous pericardial effusions. The type of effusion was not associated with outcome. Cytology (measured in 164) was positive in 58% and only weakly related to outcome (median survival nine versus 18 weeks, p = 0.04). Per our institutional practice, a pericardial catheter was left in place until there were less than 50 ml of net drainage in 24 hours (average 3 ± 2 days). A total of 135 patients had metastatic carcinoma, 23 patients had lymphoma or chronic leukemia and 4 metastatic sarcoma. Patients with either lymphoma or chronic leukemia had better survival than those with carcinoma or sarcoma (median survival 102 vs 12 weeks, p < 0.0001) with a 46% vs 3% 5-year survival, p < 0.0001). Echoguided pericardiocentesis with extended pericardial catheter placement is safe and effective in cancer patients with pericardial effusions. However, overall outcomes are poor in cancer patients with pericardial effusions that required drainage, particularly in those with carcinoma or sarcoma.

CARDIAC MRI IN DIAGNOSING AND TREATING PERICARDIAL DISEASE: A CASE OF EFFUSIVE CONSTRICTIVE PERICARDITIS WITH RECURRENT CARDIOGENIC SHOCK

Effusive constrictive pericarditis is a rare but important cause of pericardial effusion and cardiogenic shock. A 79-year-old woman with a history of a pituitary macroadenoma with recent transphenoidal resection presented to the emergency department with dyspnea and hypotension. The patient had two

A rare cause of pericardial effusion and ascites: POEMS syndrome.

POEMS syndrome is an important paraneoplastic syndrome associated with multisystem involvement. Extravascular volume overload like pericardial effusion and ascites has a broad differential diagnosis. In addition, it may be initial presentation of disease. For that reason, this case report is highlight to warn of different forms of presentation of poems syndrome.

Derrame pericárdico. Taponamiento cardíaco

IntroductionPericardial effusion is defined as the non-physiological presence of fluid in the pericardial sac. When increased intrapericardial pressure restricts the effective filling of the heart cavities this causes the serious haemodynamic situation of cardiac tamponade. AetiologyIn our environment, the principal cause of pericardial effusion is idiopathic. Cardiac taponade can develop in the event of a pericardial effusion of any origin. Clinical manifestationsThe symptoms associated with pericardial effusion are secondary to mechanical compression of the neighbouring structures. The main clinical signs that a patient with cardiac taponade can present are tachycardia, arterial hypotension, increased jugular vein pressure, diminished heart sounds and pulsus paradoxus. DiagnosisTransthoracic echocardiogram is the diagnostic test of choice for both conditions. TreatmentTreatment of pericardial effusion depends on its aetiology. Emergency drainage of the pericardial fluid is recommended by means of percutaneous pericardiocentesis or surgical drainage to treat the cardiac taponade.

A systematic review of the efficacy and safety of intrapericardial fibrinolysis in patients with pericardial effusion

Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. The complications of pericardial effusion can either be acute (e.g., cardiac tamponade) or chronic (e.g., constrictive pericarditis). We have conducted a systematic review of the scientific literature to evaluate the efficacy and safety of intrapericardial fibrinolysis in preventing complications of pericardial effusion. We searched for both published and unpublished studies. 29 studies, with a total of 109 patients were included in this review; 17 case reports, 11 case series, and one randomised controlled trial (RCT). All included studies had a high risk of bias. The most common causes of pericardial effusion were Staphylococcus aureus (12 studies with 23 cases) and Mycobacterium tuberculosis (2 studies with 19 cases). The most common fibrinolytic agents used were streptokinase (15 studies) and urokinase (5 studies). Intrapericardial fibrinolysis prevented complications in 94 (86.2%) patients. Non-fatal procedure-related complications were reported 21 (19.2%) patients. No patient died following intrapericardial fibrinolysis. There is very low certainty of the efficiency and safety of intrapericardial fibrinolysis in preventing the complications of pericardial effusion. High quality RCTs are required to address this question.

Predictors and Outcome of Pericardial Effusion After Hematopoietic Stem Cell Transplantation in Children

Pericardial Effusion (PE) is a potentially life-threatening complication of Hematopoietic Cell Transplantation (HCT). Our study aim was to identify incidence, risk factors, response to treatment, and outcome of PE after pediatric HCT. All patients after HCT at our tertiary center between 2005 and 2010 were included. Endpoints were PE development and overall survival. We analyzed patient factors, HCT details, and complications and used Cox proportional hazard regression modeling to identify predictors for PE. Twelve out of 129 patients (9.3%) developed PE. Multivariate analysis demonstrated that young age at HCT was a predictor for PE: expressed per year increase in age HR = 0.66 (95% CI 0.46–0.95, p = 0.03). PE had no impact on overall mortality of HCT. Mild respiratory symptoms and vomiting were presenting symptoms for PE. Discontinuation of calcineurin inhibitors—with or without pericardiocentesis—was the only effective treatment for PE, in contrast to diuretics or increased immunosuppression. Seven of 12 PE patients had pericardiocentesis, which was safe and effective in all. Pericardial effusion is not rare after HCT, and young age is the only significant risk factor. Calcineurin inhibitor toxicity appears to be the primary cause of PE after HCT, and discontinuation is effective in the reduction of PE. Pericardiocentesis for PE is a safe and effective procedure. Pericardial effusion did not have an impact on survival after HCT.

Dasatinib related pericardial effusion requiring pericardial drainage

Introduction Dasatinib is an oral Bcr-Abl and Src family tyrosine kinase inhibitor approved for use in patients with chronic myelogenous leukaemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukaemia (ALL). Its common side effects include myelosuppression, oedema, diarrhea and nausea. It has also been associated with the formation of pleural and pericardial effusions. As a result, Dasatinib is to be avoided in patients with pre-existing effusions or predisposition to respiratory or cardiovascular disease. Case description A fit 62-year-old pilot with no relevant medical history was diagnosed with CML in 2014, and commenced on Dasatinib therapy (100mg OD). A subsequent trans-thoracic echocardiogram (TTE) revealed normal ventricles and cardiac valves. There was however a mild to moderate global pericardial effusion, without haemodynamic compromise. This was regularly monitored with TTEs and remained stable until May 2016, where it measured 2.1cm posteriorly around the LV and 1.0 cm around the RV. Due restrictions imposed by the Civil Aviation Authority in the UK, the patient was referred for pericardial window procedure, prior to being considered fit for flying. Conclusions Dasatinib is known to cause pleural and pericardial effusions. This has been reported in patients without any predisposing factors.(1) The link with pericardial effusions has been proven with robust statistical analysis.(2) No specific mechanism has been proposed but an immune mediated reaction or off target inhibition of growth factors may be involved.(3) Management includes dose interruption or reduction, and/or treatment with steroids.(3) Our case report re-enforces that Dasatinib is an important cause of pericardial effusion and TTE is the modality of choice for follow-up. Pericardial window and drainage may be needed in patients where this prohibits them from undertaking employment. Take-home message Dasatinib related pericardial effusions are a documented side effect of therapy. One should be vigilant in monitoring patients on the drug as effusions may progress over time and require intervention. TTE is the monitoring modality of choice. As far as we are aware this is the first case report for surgical intervention in a patient with Dasatinib induced pericardial effusion.

Getting to the heart of hypopituitarism

A 53-year-old woman was diagnosed with hypopituitarism following an acute presentation with cardiac tamponade and hyponatraemia, having recently been investigated for a pericardial effusion. Secondary hypothyroidism is a rare cause of pericardial effusion and tamponade, but an important differential to consider. Management requires appropriate hormone replacement and, critically, a low threshold for commencing stress dose steroids. Clinical signs classically associated with cardiac tamponade are frequently absent in cases of tamponade due to primary and secondary hypothyroidism, and the relatively volume deplete state of secondary hypoadrenalism in hypopituitarism may further mask an evolving tamponade, as the rise in right atrial pressure is less marked even in the presence of large effusion. Our case demonstrates the importance of a high index of suspicion for cardiac tamponade in this patient cohort, even in the absence of clinical signs, and for measuring both thyroid-stimulating hormone and thyroxine levels when evaluating a pericardial effusion.

Video-assisted thoracoscopic pericardial window for massive pericardial effusion: South Egypt experience

BackgroundSymptomatic pericardial effusion (PE) is a common cardiothoracic presentation. It may reflect a wide variety of causes, ranging from infection to malignancy. The optimal management of pericardial effusion is still controversial. The two main interventional procedures agreed in the last decade as the two reasonable options for PE treatment are: surgical (transthoracic or subxiphoid) and video-assisted thoracoscopy (VATS) pericardial window. In this study we report our experience in VATS pericardial window in the management of massive pericardial effusion. MethodsThis prospective study was conducted between May 2013 to December 2015. Patients with massive pericardial effusion with or without tamponade, diagnosed by transthoracic echocardiography, and sometimes with chest computed tomography (CT) scan were included. ResultsFifty-three patients with massive PE were included in the study, 33 males and 20 females, aged from 20 to 55 years. The causes of PE were malignancy 15 cases; uremia 5 cases; tuberculosis 8 cases; chronic non specific inflammation 13 cases and idiopathic in 12 cases. The main clinical presentation was dyspnea in the majority of cases (57%), followed by fever (15%), chest pain (8%), and (7.5%) were asymptomatic at time of presentation. 7 cases (13%) were unstable with signs of tamponade. The amount of fluid drained averaged 450 ± 95 ml (from 350 to 600 ml). The mean operative time was 120.45 ± 34.67 min. Lung injury, air leak, transient ventricular arrhythmias, and atelectasis were the main complications. The mean hospital stay was 9 days, and the mean chest tube duration was 4.3 days. There were no perioperative deaths. The Thirty-day mortality was 11%. Recurrence occurred in 3 patients (5.6%). ConclusionsVATS pericardial window is an effective, safe and minimally-invasive technique for PE drainage and taking pericardial, pleural and lung biopsies.

ИЗОЛИРОВАННЫЙ ГИДРОПЕРИКАРД − СЛЕДСТВИЕ ПОЗДНЕЙ ДИАГНОСТИКИ ПЕРВИЧНОГО ГИПОТИРЕОЗА

Background. In therapeutic practice the diagnostics of hypothyroidism can be difficult due to its non-specific&nbsp;nature and symptoms diversity.&nbsp;Goal. To present the result of successful diagnostics and treatment of primary hypothyroidism, where&nbsp;hydropericardium was defined as the main symptom of the disease.Material and methods. A case of late diagnosis of primary hypothyroidism in a female aged 50 with hydropericardium&nbsp;is described. The tactics of examination of the patient according to the recommendations of the European Society of&nbsp;Cardiology (2015) with the purpose of excluding metabolic causes of pericardial effusion is presented.Results. The ignoring of the most frequent symptoms of hypothyroidism was found to be the reason for late&nbsp;diagnostics of the disease, hydropericardium being considered the primary disease.Conclusions. In order to exclude metabolic causes of pericardial effusion during the examination of patients with&nbsp;the diseases of pericardium, evaluation of the thyroid function is warranted.

Severe right ventricular and tricuspid valve dysfunction after pericardiocentesis

Pericardiocentesis is performed to treat cardiac tamponade or diagnose the cause of pericardial effusion. Cardiogenic shock with right ventricular (RV) dysfunction is a rare complication after pericardiocentesis. We report a case of an 82-year-old man who suddenly suffered cardiopulmonary arrest 12h after pericardiocentesis. A transthoracic echocardiogram showed remarkable RV dysfunction and tricuspid valve dysfunction. Tricuspid valve closure was severely impaired, and the tricuspid regurgitation signal showed laminar flow with an early peak. However, after treatment with high-dose inotropic drugs, hemodynamic parameters gradually recovered. A transthoracic echocardiogram performed 24h later showed improved motion of the RV and the tricuspid valve, resulting in a reduction in tricuspid regurgitation. RV and tricuspid valve dysfunction after pericardiocentesis needs to be recognized as a critical complication. Physicians also need to pay attention to not only the amount of drainage but also underlying RV dysfunction.

Cardiac tamponade due to hypothyroidism: a case cluster report

This study reports on three patients who were seen at Tygerberg Hospital within a short period of six months, with a new diagnosis of biochemically severe primary hypothyroidism. Pericardial effusion was suspected on clinical and X-ray findings and confirmed with echocardiography in all cases. All had evidence of pericardial tamponade based on echocardiographic criteria. Pericardiocentesis was performed on all patients and other causes of pericardial effusions were excluded. Although infrequently described, hypothyroidism needs to be considered in patients presenting with unexplained large pericardial effusions and cardiac tamponade.