Pericardial effusion due to cholesterol pericarditis in case of rheumatoid arthritis
A 53yearold male patient with a history of rheumatoid arthritis presented with exertional dyspnea and abdominal distension and having had pleuritic chest pain for approximately one month. His medical treatment for rheumatoid arthritis was salicylazosulfapyridine, hydroxychloroquine, prednisolone, and leflunomide. Upon physical examination, his blood pressure was 95/65 mm Hg, his heart rate was 112 bpm, and his oxygen saturation was 94 percent. The electrocardiogram (ECG) showed sinus tachycardia and lowvoltage QRS complex. Transthoracic echocardiography revealed a large, hyperechogenic, and circumferential pericardial effusion (Fig. 1, Video S1) with right ventricular diastolic collapse (Fig. 2) respiratory variation in mitral inflow velocity, and inferior vena cava (IVC) plethora. Computer tomography revealed a circumferential hyperdense fluid image around the heart (Fig. 3) After these findings, we aspirated approximately 900 mL yellow fluid with gold paint (Fig. 4)
Echocardiography