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JAMA Cardiology Clinical Challenge
January 22, 2020

A 61-Year-Old Woman With New Pericardial Effusion

Author Affiliations
  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Cardiol. 2020;5(3):357-358. doi:10.1001/jamacardio.2019.5276

A 61-year-old woman presented with pleuritic chest pain, shortness of breath, and syncope. She had a medical history of end-stage renal disease secondary to autosomal dominant polycystic kidney disease, after renal transplant 5 years prior. She had concomitant polycystic liver disease and had undergone right hepatectomy and cyst fenestration, plus inferior vena cava (IVC) stent placement for intrahepatic caval compression due to hepatic cysts 9 years earlier. Initial laboratory evaluation results revealed elevated creatinine levels with concern of renal graft failure. Physical examination results revealed a blood pressure of 96/65 mm Hg, an elevated jugular venous pressure with blunted Y-descent, Kussmaul sign, and distant heart sounds. Chest radiography results revealed cardiomegaly and the IVC stent was evident, adjacent to her heart (Figure, A). Echocardiography (Video 1 and Figure, B) revealed a large circumferential pericardial effusion, diastolic right ventricular collapse, and exaggerated respiratory variation (>25%) in the mitral inflow velocity but a normal inferior vena cava size.