Spontaneous Biliary Pericardial Tamponade: A Case Report and Literature Review

• Published in: Current cardiology reviews Vol. 17; no. 2; pp. 204 - 208
• Main Authors: Battisha, Ayman, Altibi, Ahmed M., Madoukh, Bader, Sheikh, Omar, Sawalha, Khalid, Shaikh, Shakil, Al-Sadawi, Mohammed
• Format: Journal Article
• Language: English
• Published: United Arab Emirates Bentham Science Publishers Ltd 2021; Benham Science Publishers; Bentham Science Publishers
• Subjects: Adult; Aged; Biliary Tract Diseases; Bilirubin; Cardiac Tamponade; Case reports; Chest; Dyspnea; Etiology; Female; Fistula; Fistulae; Humans; Iminodiacetic acid; Literature reviews; Male; Malignancy; Middle Aged; Pericardiocentesis; Respiration; Surgery; Tamponade; Thoracic surgery; Trauma; pericardiocentesis; cardiac tamponade; biliary cardiac effusion; pericardiobiliary fistula; BPT; Pericardial effusion
• ISSN: 1573-403X; 1875-6557; 1875-6557
• DOI: 10.2174/1573403X16666200611132045

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.