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J Emerg Med. 2017 Apr;52(4):e105-e109. doi: 10.1016/j.jemermed.2016.10.023. Epub 2017 Jan 20.

Hemorrhagic Pericardial Cyst Diagnosis Accelerated by Emergency Physician Echocardiography: A Case Report.

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1
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
2
Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, Connecticut.

Abstract

BACKGROUND:

The differential diagnosis for chest pain in the emergency department is broad and includes both benign and life-threatening conditions-with pericardial cyst as a rare example. Emergency physician-performed point-of-care focused cardiac ultrasound (FOCUS) is increasingly recognized as a useful modality in the evaluation of patients with chest pain.

CASE REPORT:

We report a case of hemorrhagic pericardial cyst in a young woman presenting with chest pain in which findings on FOCUS contradicted findings on chest x-ray study and thus, accelerated diagnosis and definitive treatment. We also comment on epidemiology, pathophysiology, clinical presentation, diagnosis, and management of this uncommon, potentially fatal cause of chest pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring an uncommon case to the attention of emergency providers and emphasize the importance of facility with FOCUS. Although definitive diagnosis and management were not accomplished at the bedside in this case, an abnormal finding on FOCUS prompted further investigation and timely treatment.

KEYWORDS:

cardiac; cardiomegaly; chest pain; echocardiogram; echocardiography; emergency department; emergency radiography; emergency radiology; focused cardiac ultrasonography; mediastinal mass; pericardial; pericardial cyst; point-of-care; ultrasound

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