Introduction
Purulent pericarditis (PP) is a devastating condition with a high
mortality rate of around 40% even after appropriate medical and
surgical treatment.[1, 2] Surgical pericardiectomy can prevent
progression to the feared long-term complication of constrictive
pericarditis but carries high mortality of nearly 8%.[3]
Intrapericardial administration of a fibrinolytic agent (IFA) such as
urokinase has been shown to be effective in preventing constriction in
one randomized clinical trial.[4] A decrease in fibrin content which
is commonly associated with infection with a consequent decrease in
pericardial fibrosis is the suggested mechanism for a decrease in the
incidence of pericardial constriction following IFA.[5, 6] Because
of this, IFA has been recommended by some in the management of PP.[7,
8] In this report, we present an adult patient with PP in whom
two-dimensional transthoracic echocardiography (2DTTE) demonstrated a
marked decrease in the area of the right ventricular (RV) wall together
with the overlying fibrin following IFA as compared to the baseline.
These 2DTTE findings are consistent with a substantial decrease in
fibrin content following IFA. To the best of our knowledge, these
findings have not been documented before with illustrations of both pre
and post IFA 2DTTE measurements in an adult with PP.