# Prehospital Detection of a Large Pericardial Effusion Using Screening Sonography: A Case Report

## TL;DR

A case report shows how screening ultrasound in prehospital settings can detect life-threatening pericardial effusion and improve patient outcomes.

## Contribution

Demonstrates the utility of bedside ultrasound in detecting pericardial effusion in resource-limited emergency settings.

## Key findings

- A bedside screening ultrasound identified a large pericardial effusion in a patient with ambiguous symptoms.
- Early detection via ultrasound enabled urgent referral and confirmed diagnosis in a central hospital.
- The case highlights the importance of trained personnel to perform and interpret such ultrasounds.

## Abstract

Pericardial effusion, although not uncommon in emergency contexts, poses detection and diagnostic challenges in prehospital and peripheral emergency settings where access to advanced imaging and specialist evaluation is limited. In its severe forms, rapid fluid accumulation may lead to cardiac tamponade, a life-threatening condition requiring immediate recognition and intervention. The clinical course is often insidious, and the progression of symptoms may easily be mistaken for other, more common pathologies, further complicating timely diagnosis. We report the case of a patient who presented twice within two days to a Basic Emergency Service with central chest pain of five days’ duration, low-grade fever, and subsequently worsening dyspnea. Given the persistence and evolution of symptoms, a bedside screening ultrasound was performed, which revealed a large pericardial effusion. The patient was urgently referred to a central hospital, where the diagnosis was confirmed, and appropriate management was instituted. This case illustrates the vital function of screening ultrasound in resource-limited environments: even when definitive treatment cannot be provided locally, early identification of critical findings supports timely referral and improves patient outcomes. Furthermore, the decision to employ or omit screening echocardiography in such contexts can significantly influence clinical pathways and ultimately alter patient prognosis, emphasizing its relevance as a low-cost, rapidly deployable screening tool, while also stressing that patient outcomes may depend on the availability of a trained sonographer/radiographer capable of performing the examination.