CASE REPORT OF MASSIVE RECURRENT PERICARDIAL EFFUSION SECONDARY TO HYPOTHYROIDISM

Background:Although relatively rare, pericardial effusions secondary to hypothyroidism have been well described (1). Moderate to large pericardial effusions are rare and associated tamponade is extremely rare (2). A wide variety of conditions can cause a pericardial effusion. Early recognition of a pericardial effusion and its underlying cause are important for improving prognosis and can avoid unnecessarily invasive investigations. Case presentation:62-year-old female patient without cardiovascular risk factors and treated for depression, admitted for the management of a state III dyspnea with severe asthenia Malaise and general weakness were also noted. The Cardiovascular Examination finds: Decreased Heart Sounds, with Signs of Right Heart Failure including Jugular Vein Turgescence with Hepatic jugular Reflux and Hepatomegaly, as well as lower limb edema reaching mid-leg. Pleuropulmonary examination found: VM decreased at baseline SpO2 = 80%. Abdominal examination found: Hepatomegaly. EKG:Sinuses and regular Rhythm at 80 BPM. And a diffuse Micro Voltage Chest X-ray:shows cardiomegaly with a CTI> 0.6 and bilateral hilar overload with bilateral basithoracic pleural effusion. Transthoracic echocardiography was performed urgently at admission, which revealed circumferential pericardial effusion of great abundance. The patient benefited the same day from a pericardial puncture with good clinical evolution. The transthoracique echocardiography shows the persistence of low to moderate abundance of pericardial effusion, without pathological respiratory variations. No collapse of the VD-OD The thoracoabdominopelvic CT scan shows the pericardial effusion and a sequential coronal renal notch.Biologically assessment: the patient has normochromic normocytic anemia with leucopenia (neutropenia) and hypothyroidism. The patient is transferred to cardiovascular chirurgical department for drainage and pleuropericardial window under medical treatment Conclusion:Hypothyroidism should be ruled out in all patients with an unexplained pericardial effusion. The corollary is that, in hypothyroid patients, other more common causes of a pericardial effusion should be excluded. In patients with a large pericardial effusion due to hypothyroidism, cardiac tamponade may be present without significant tachycardia.