Ayman Battisha*, Ahmed M Altibi, Bader Madoukh, Omar Sheikh, Khalid Sawalha, Shakil Shaikh and Mohammed Al-Sadawi Pages 204 - 208 ( 5 )
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 pericardiobiliary fistula. However, BPT in the absence of a detectable fistula is extremely rare.Learning objective: A biliary pericardial tamponade is a rare form of tamponade warranting a prompt workup (e.g., MRCP or HIDA scan) for a potential fistula between the biliary system and the pericardial space. A pericardio-biliary fistula can be iatrogenic or traumatic. People with a history of chest wall trauma, abdominal surgery, or chest surgery are at increased risk. The use of HIDA scanning plays a salient role in effectively surveilling for the presence of a fistula – especially when MRCP is contraindicated. Case Presentation: A 75-year-old Hispanic male presenting with dyspnea and diagnosed with cardiac tamponade is the subject of the study. Subsequent pericardiocentesis revealed biliary pericardial fluid (bilirubin of 7.6 mg/dl). The patient underwent extensive workup to identify a potential fistula between the 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, with a 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.
Pericardial effusion, cardiac tamponade, biliary cardiac effusion, pericardiobiliary fistula, BPT, pericardiocentesis.
University of Massachusetts Medical School, Baystate, Springfield, MA 01107, Henry Ford Allegiance Health Hospital, Jackson, MA 49201, Overland Park Regional Medical Center, Overland Park, KS 66215, University of Texas Health Science Center at San Antonio, San Antonio, TX, University of Massachusetts Medical School, Baystate, Springfield, MA 01107, State University of New York: Downstate Medical Center, Brooklyn, NY 11202, State University of New York: Downstate Medical Center, Brooklyn, NY 11202