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Current Cardiology Reviews


ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

General Review Article

Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review

Author(s): Ayman Battisha*, Ahmed M. Altibi, Bader Madoukh, Omar Sheikh, Khalid Sawalha, Shakil Shaikh and Mohammed Al-Sadawi

Volume 17, Issue 2, 2021

Published on: 11 June, 2020

Page: [204 - 208] Pages: 5

DOI: 10.2174/1573403X16666200611132045

Price: $65


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.

Keywords: Pericardial effusion, cardiac tamponade, biliary cardiac effusion, pericardiobiliary fistula, BPT, pericardiocentesis.

Graphical Abstract

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