CLINICAL, ECHOCARDIOGRAPHIC, AND HEMODYNAMIC EVIDENCE OF CARDIAC-TAMPONADE CAUSED BY LARGE PLEURAL EFFUSIONS

Large pleural effusions are typically associated with dyspnea and pote ntial respiratory compromise, Experimental evidence suggests that with large effusions, increased intrapleural pressure may be transmitted t o the pericardial space, resulting in impaired cardiac filling and red uced stroke volume. We report two cases in which large pleural collect ions were complicated by hypotension. The effusions were due to an inf ected right hepatic hydrothorax (Case 1) and a left malignant effusion (Case 2), Echocardiography demonstrated right and left ventricular di astolic collapse, respectively, confirming a diagnosis of cardiac tamp onade. Large volume thoracentesis resulted in immediate hemodynamic im provement as demonstrated by a reduction in right ventricular and atri al pressures (Case 1) and echocardiographic resolution of left ventric ular diastolic collapse (Case 2). These cases establish that large ple ural effusions can cause hemodynamically significant cardiac tamponade . In addition, they illustrate how the demonstration of cardiac compre ssive physiology can significantly alter the therapeutic approach to l arge pleural effusions.