Pseudomonas aeruginosa-related effusive-constrictive pericarditis diagnosed with echocardiography: A case report

Table 1 Timeline

Day 1	A 30-yr-old man was admitted to our hospital with a 2-mo history of cough, dyspnea, bloating, palpitation, and lower extremity oedema
Day 2	The patient was taken to the ultrasound department for an echocardiogram showing a moderate-sized localized pericardial effusion, with an increase in the RAD and LAD (Figure 1)
Day 5	The patient underwent pericardiocentesis to relieve the clinical conditions
Day 6	The patient's clinical symptoms were slightly relieved
Day 8	A repeat echocardiogram showed decreased pericardial effusion compared with the first examination and characteristic manifestations of pericardial constriction. A diagnosis of ECP was established (Figure 2)
Day 10	A CT scan demonstrated a small amount of pericardial effusion with thickened pericardium
Day 15	PET-CT examination ruled out neoplastic and connective tissue diseases
Day 17	The patient underwent pericardectomy, which led to a rapid improvement in the clinical symptoms
Day 19	Histologic examination performed on the pericardial tissue obtained during pericardectomy showed increased thickening with the proliferation of collagen fibers, hyaline degeneration, and calcification (Figure 4)
Day 20	Cytologic examination of the pericardial fluid obtained during pericardectomy showed many inflammatory cells and few mesothelial cells. Cultures of the pericardial fluid and pericardium grew Pseudomonas aeruginosa
Day 24	A repeat 2D-TTE 1 wk after pericardectomy revealed improvement in the biatrial diameter, Doppler features of pericardial constriction, and the right atrial pressure (Figure 3)
Day 26	The patient was discharged home in stable condition
1 mo post-discharge	A follow-up echocardiogram revealed that the right atrial pressure assessed using echocardiography had significantly decreased in the absence of pericardial constriction echocardiographic features (Figure 5)

RAD: Right atrium dimension; LAD: Left atrium dimension; ECP: Effusive-constrictive pericarditis; 2D-TTE: two-dimensional transthoracic echocardiography; PET: Positron emission tomography; CT: Computed tomography.