Lm. Kaplan et al., CLINICAL, ECHOCARDIOGRAPHIC, AND HEMODYNAMIC EVIDENCE OF CARDIAC-TAMPONADE CAUSED BY LARGE PLEURAL EFFUSIONS, American journal of respiratory and critical care medicine, 151(3), 1995, pp. 904-908
Citations number
27
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
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.