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2015 ; 8
(1
): 36
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Intrapericardial fibrinolysis in purulent pericarditis-case report
#MMPMID26446031
Dybowska M
; Kazanecka B
; Kuca P
; Burakowski J
; Czajka C
; Grzegorczyk F
; Gralec R
; Tomkowski W
Int J Emerg Med
2015[Dec]; 8
(1
): 36
PMID26446031
show ga
Purulent pericarditis (PP) continues to result in a very serious prognosis and
high mortality. The most serious complication of pericarditis is constriction.
Intrapericardial administration of fibrinolytic agents, although controversial,
can prevent the development of constrictions. We present the case of a
63-year-old man with purulent inflammation of the right knee who was admitted to
the intensive care unit (ICU) via emergency room orthopedic evaluation because of
purulent pericarditis. Subxiphoid pericardiotomy was urgently performed, with
1200 ml of thick purulent fluid evacuated. As prevention for pericardial
constriction, it was decided to administer fibrinolysis to the patient's
pericardial cavity. Administration of streptokinase was complicated by the
occurrence of a severe retrosternal pain and intrapericardial bleeding. Due to
insufficiency of antibiotic therapy, 17 days after complicated fibrinolytic
therapy with streptokinase, it was decided to administer 20 mg of r-tPA directly
into the pericardium. In the following days, there remained a high drainage of
purulent secretions. Fever up to 38 °C was still observed despite the use of
antibiotics. Nine days after first administration of r-tPA, it was decided to
apply the next dose. Daily drainage decreased from 50 to 20 ml in successive
days. No fluid accumulation and symptoms and signs of constrictions were observed
in clinical examinations as well as in echocardiography performed during 7 years
follow-up after discharge.