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■ LESSON OF THE MONTH Clinical Medicine 2010, Vol 10, No 1: 88–90 lesson of the month (2) 6.5 g/l. The patient’s symptoms improved rapidly following Delayed pericardial effusions: life- drainage. Over 1.5 litres of haemorrhagic effusion were drained in a 36-hour period. He was transferred to a cardiothoracic surgical threatening complication presenting up centre where a cardiac computed tomography scan confirmed a to 100 days after chest trauma residual loculated effusion. Median sternotomy was performed for surgical exploration of Stab wounds are often managed conservatively with the pericardial space. The pericardium was thickened and, upon simple wound assessment and closure. However, even opening, a further 450 mls of serous fluid was drained. No apparently minor thoracic wounds can cause delayed obvious trauma or scarring of the right ventricle was seen. The pericardial effusions presenting as life-threatening patient has ongoing follow-up and remains well. tamponade sometimes days, weeks or months later. Patients suffering stab wounds to the chest should receive echocardiographic follow-up to exclude Discussion delayed pericardial effusions. Acute pericardial effusion and cardiac tamponade can follow penetrating cardiac trauma and immediate drainage, followed by surgical exploration and repair, is required. Delayed peri- Lesson cardial effusions following thoracic trauma are much less common but can present unexpectedly, are potentially fatal A 21-year-old man was stabbed once with a three inch blade to and are preventable. the right of the xiphoid process. In the emergency department Pericardial effusions typically present with dyspnoea. Large he was intoxicated with alcohol and combative but clinically effusions may compress local structures causing dysphagia, well. Blood pressure was 107/77 mmHg and an initial tachy- cough, hoarseness and hiccoughs. Chest radiographs may demon- cardia of 145 beats per minute resolved with analgesia. The strate an enlarged ‘globular shaped heart’. Electrocardiography wound was not bleeding and on external examination was may demonstrate beat to beat variation in the amplitude of t
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