Today’s lecture was about a patient with EtOH abuse presenting with dyspnea, leg pain. POCUS that was performed secondary to low BP showed large pericardial effusion. Physiology of tamponade was discussed including physical exam (with live demonstration with audience participation!) and echo findings.
Laboratory workup and pericardiocentesis (which yielded bloody pericardial fluid) did not reveal the etiology but when patient developed rash and bruising they were ultimately diagnosed with hemorrhagic pericardial effusion secondary to scurvy. They were treated with Vitamin C and symptoms resolved.
Take home points:
Recognize clinical signs and exam findings of pericardial effusion
Understand the differential diagnosis of pericardial effusion
Recognition and management of cardiac tamponade
Scurvy is re-emerging in the malnourished (often alcoholic) patient population
The clinical presentation of scurvy is mostly secondary to impaired collagen synthesis