Abstract 14547: A Rare Case of Pericardial Effusion Causing Cardiac Tamponade in Preeclampsia

Background: Cardiovascular manifestations of preeclampsia are caused by increased peripheral vascular resistance and systemic endothelial damage causing third spacing of fluids. Usually this presents as lower extremity edema or non-cardiogenic pulmonary edema. Here we report a rare case of third spacing into pericardial space causing cardiac tamponade in a patient with severe pre-eclampsia. To our knowledge, only 2 similar cases have been reported so far. Case presentation: 35-year-old female G1P0A0 presented to the hospital at 36 weeks and 6 days of gestation with complaints of elevated blood pressure, headache, blurring of vision, and shortness of breath. On physical exam, she had blood pressure of 170/85, 3+ bilateral lower extremity edema and labs showed urine protein to creatinine ratio of 13,962. She was diagnosed with severe pre-eclampsia and underwent emergent C-section without any complications. On postoperative day 1, patient continued to complain of shortness of breath and became hypoxic requiring 2 to 3 L of supplemental oxygen. Chest x-ray showed slight pulmonary edema but BNP was 49. She had persistent lower extremity swelling and was empirically diuresed with IV Lasix with some improvement in her symptoms. An echocardiogram showed large circumferential pericardial effusion with early right ventricular diastolic collapse consistent with cardiac tamponade. Her LV function was normal with an EF of 70% without any wall motion abnormalities. She was taken to the Cath Lab for pericardiocentesis and underwent drainage of almost 650 cc of yellowish clear-colored fluid. Analysis of the fluid showed 1186 nucleated cells, pH 7.5, and protein of 2.9 mg/dl. Her ANA and Rheumatoid factor were negative. The pericardial drain was removed after 5 days with no evidence of recurrence of tamponade on repeat echo. Conclusion: Peripartum shortness of breath with leg swelling is a common complain among pregnant women with pre-eclampsia. Although peripartum cardiomyopathy is more common, pericardial effusion with cardiac tamponade is also a potential diagnosis and should be kept in the differential. Echocardiography can differentiate these entities.