# Localized Reaccumulation of Pericardial Effusion After Pericardial Fenestration Undetected on Frontal Chest Radiography

## TL;DR

A patient with lung cancer developed pericardial effusion that reaccumulated after surgery, but it was not visible on standard chest X-rays.

## Contribution

Highlights the limitations of frontal chest radiography in detecting localized pericardial effusion reaccumulation after fenestration.

## Key findings

- Pericardial effusion reaccumulated after fenestration but was not visible on frontal chest X-ray.
- Autopsy CT showed heterogeneous reaccumulation due to adhesions around the fenestration site.
- Worsening respiratory condition after fenestration may require additional imaging beyond standard X-rays.

## Abstract

A 70-year-old man with advanced lung adenocarcinoma visited our hospital complaining of dyspnea. He was diagnosed with cardiac tamponade and underwent pericardial drainage. Pericardial effusion reaccumulated in 73 days, and right pericardial fenestration was performed. Although his respiratory condition worsened three weeks after the surgery, his chest X-ray showed little change. He died of respiratory failure the next day. Autopsy CT revealed heterogeneously reaccumulated pericardial effusion in the pericardial cavity, which was difficult to detect by frontal chest X-ray. An autopsy revealed adhesions around the fenestration site. Pericardial effusion may heterogeneously reaccumulate in the pericardial cavity due to adhesions. When the respiratory condition worsens even after fenestration for cardiac tamponade, lateral imaging, echocardiography, and chest CT should also be considered.