Recurrent pericardial effusion due to retained cardiac pellets: a case report and review of the literature.

A 52-year-old man presented with severe dyspnea 6 months after a thoracic firearm injury. Many pellets distributed in the thoracic wall and an enlarged cardiac silhouette were detected on chest X-ray. There was low voltage in all 12 leads and electrical alternans on electrocardiography. Echocardiography showed a massive pericardial effusion causing cardiac tamponade. Pericardial drainage was performed and 2 400 cc of hemorrhagic fluid was drained using a sheath and pigtail catheter. Coronary arteries were evaluated as normal by angiography, but four pellets which were moving simultaneously within the heart were detected on cardiac fluoroscopy. We thought that the recurrent pericardial effusion in our patient was secondary to pericardial damage due to the gunshot wound, as is seen in postpericardiotomy syndrome. An excellent result was achieved by drainage of the pericardial fluid and oral administration of indomethacin plus prednisolone treatment.