Pericardial Decompression Syndrome

This case report describes a 14-year-old boy who developed acute hypotension and right ventricular failure after urgent pericardiocentesis for tamponade caused by a large pericardial effusion. Within minutes of draining 850 ml of sanguineous fluid, repeat imaging revealed right ventricular dilation, biventricular dysfunction, and severe tricuspid regurgitation. No anatomical injury was found. A diagnosis of pericardial decompression syndrome, a rare complication where rapid fluid removal leads to transient ventricular dysfunction without direct trauma—was made. Supportive ICU care stabilized the patient, and cardiac function normalized by day 10. B-cell lymphoma was later identified as the underlying cause of the effusion, and chemotherapy was initiated. The patient’s cardiac recovery remained intact at 1-month follow-up.

This case report describes a 14-year-old boy who developed acute hypotension and right ventricular failure after urgent pericardiocentesis for tamponade caused by a large pericardial effusion. Within minutes of draining 850 ml of sanguineous fluid, repeat imaging revealed right ventricular dilation, biventricular dysfunction, and severe tricuspid regurgitation. No anatomical injury was found. A diagnosis of pericardial decompression syndrome, a rare complication where rapid fluid removal leads to transient ventricular dysfunction without direct trauma—was made. Supportive ICU care stabilized the patient, and cardiac function normalized by day 10. B-cell lymphoma was later identified as the underlying cause of the effusion, and chemotherapy was initiated. The patient’s cardiac recovery remained intact at 1-month follow-up.