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Fever, edema, and shortness of breath: the Scrhödinger’s cat paradox displayed on pericardium

  • Elisa Gesu
  • Guido Gelpi
  • Stefania Piconi
  • Ilaria Righi
  • Maria Carmela Andrisani
  • Enrico Garanzini
  • Valentina Vespro
  • Giorgio Costantino
IM - CASE RECORD
  • 66 Downloads

Case presentation

In June 2017, a 50-year-old woman was admitted to our ward with fever, edema of the lower limbs, jugular turgor, fatigue, tachycardia, and dyspnea of 2 weeks duration. In the Emergency Department (ED), the patient was febrile (38 °C); the physical examination showed signs of right heart failure with tachycardia (110 bpm), hypotension (90/60 mmHg), and peripheral oxygen saturation 98%. A chest X-ray study revealed a left pleural effusion; blood examinations demonstrated increased values of C-reactive protein (CRP) 8.23 mg/dl (normal values < 0.5) and international normalized ratio (INR) was 1.44; echocardiogram showed minimum anterior pericardial effusion. The ECG was normal apart from nonspecific abnormalities of ST-T waves.

Her medical history was significant for locally invasive uterine cervical squamous cell carcinoma (SCC) discovered in 2015, treated with chemotherapy and radiotherapy. Subsequent follow-up at 2 years (gynaecologic visit in April 2017) was negative...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© SIMI 2018

Authors and Affiliations

  1. 1.UOC Pronto Soccorso e Medicina d’Urgenza, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  2. 2.Dipartimento di Chirurgia Cardiovascolare, ASST Fatebenefratelli SaccoUniversità degli Studi di MilanoMilanItaly
  3. 3.Dipartimento di Malattie Infettive, ASST Fatebenefratelli SaccoUniversità degli Studi di MilanoMilanItaly
  4. 4.Dipartimento di Chirurgia Toracica e Trapianti di Polmone, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  5. 5.Dipartimento di Diagnostica per Immagini, UOC di Radiologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  6. 6.Dipartimento di Medicina Interna, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly

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