Pericardial infusion of tissue plasminogen activator in fibropurulent pericarditis

Journal of Intensive Care Medicine
Charles P ReznikoffDouglas B Coursin

Abstract

A 61-year-old man developed a loculated fibropurulent pericarditis, a rare complication of bacteremia. This occurred as a complication of a Staphylococcal aureus bacteremia from a head and neck abscess following self-extraction of a tooth. Despite surgical intervention and placement of 2 pericardial drains, a refractory, inadequately drained infected pericardial effusion persisted. Although there is limited experience with thrombolytic therapy to dissolve a fibrin clot in the pericardium, break down loculated adhesions, and facilitate free drainage of infected material, lysis is well described in the management of exudative pleural effusions. After infusion of 30 mg of tissue plasminogen activator in 100 cc normal saline through the pericardial drain of the patient, a large amount of infected serosanginous material subsequently drained during the next 2 days. The patient became afebrile and culture negative, remained hemodynamically stable, and had resolution of his pericarditis and pericardial effusion on electrocardiogram and echocardiogram, respectively.

References

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Citations

May 15, 2008·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Michael T BighamHector R Wong
May 18, 2011·Critical Care : the Official Journal of the Critical Care Forum·Pascal AugustinPhilippe Montravers
Oct 21, 2015·Critical Reviews in Microbiology·Marijke PeetermansPeter Verhamme
Jul 21, 2012·Journal of Pediatric Surgery·Anna C ShawyerJacob C Langer
Jan 27, 2007·Pharmacotherapy·Kelly K JohnsonParag Patel

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