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.