Am. J. Respir. Crit. Care Med., Vol 151, No. 3, 03 1995, 904-908.
Clinical, echocardiographic, and hemodynamic evidence of cardiac tamponade caused by large pleural effusions
LM Kaplan, SK Epstein, SL Schwartz, QL Cao and NG Pandian
Department of Medicine, New England Medical Center Hospital, Tufts University School of Medicine, Boston, Massachusetts.
Large pleural effusions are typically associated with dyspnea and potential
respiratory compromise. Experimental evidence suggests that with large
effusions, increased intrapleural pressure may be transmitted to the
pericardial space, resulting in impaired cardiac filling and reduced stroke
volume. We report two cases in which large pleural collections were
complicated by hypotension. The effusions were due to an infected right
hepatic hydrothorax (Case 1) and a left malignant effusion (Case 2).
Echocardiography demonstrated right and left ventricular diastolic
collapse, respectively, confirming a diagnosis of cardiac tamponade. Large
volume thoracentesis resulted in immediate hemodynamic improvement as
demonstrated by a reduction in right ventricular and atrial pressures (Case
1) and echocardiographic resolution of left ventricular diastolic collapse
(Case 2). These cases establish that large pleural effusions can cause
hemodynamically significant cardiac tamponade. In addition, they illustrate
how the demonstration of cardiac compressive physiology can significantly
alter the therapeutic approach to large pleural effusions.
