Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review
Internal Medicine; Medicine
Background: Biliary pericardial tamponade (BPT) is a rare form of pericardial tamponade, characterized by yellowish-greenish pericardial fluid upon pericardiocentesis. Historically, BPT reported to occur in the setting of an associated pericardio-biliary fistula. However, BPT in the absence of a detectable fistula is extremely rare.
Case presentation: A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). Patient underwent extensive workup to identify a potential fistula between hepatobiliary system and the pericardial space, which was non-revealing. The mechanism of bile entry into the pericardial space remains to be unidentified.
Literature review: A total of six previously published BPT were identified: all were males, mean age of 53.3 years (range: 31-73). Mortality was reported in two out of the six cases. The underlying etiology for pericardial tamponade varied across the cases: incidental pericardio-biliary fistula, traumatic pericardial injury, and presence of associated malignancy. - Conclusion: Biliary pericardial tamponade is a rare form of tamponade that warrants a prompt workup (e.g., Hepatobiliary Iminodiacetic Acid - HIDA scan) for an iatrogenic vs. traumatic pericardio-biliary fistula. As a first case in the literature, our case exhibits a biliary tamponade in the absence of an identifiable fistula.
Battisha A, Altibi AM, Madoukh B, et al. Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review [published online ahead of print, 2020 Jun 11]. Curr Cardiol Rev. 2020;10.2174/1573403X16666200611132045. doi:10.2174/1573403X16666200611132045