Delayed Clinical Presentation of Hemorrhagic Pericardial Effusion in a Patient Receiving Warfarin Sodium

Abstract not available. Introduction provided instead.

Acute hemorrhagic pericardial effusion is a condition that may coexist with other injuries in patients with multiple trauma. Pericardial tamponade caused by hemorrhagic effusion is an emergent condition that requires prompt treatment.¹ Subacute presentation has been reported,¹ and anticoagulation of a patient with blunt chest trauma may lead to delayed presentation.² In treating patients with multiple trauma, some orthopedic surgeons may assume the role of primary attending physician after other trauma issues are thought to be resolved. Not infrequently, patients with blunt chest injury will also have lower extremity fractures. Anticoagulation may be indicated in these patients, and orthopedic surgeons may become responsible for managing this aspect of patient care. In this scenario, orthopedic surgeons may be the first to encounter signs and symptoms associated with hemorrhagic pericardial effusion or tamponade.

In this report, I present a case of hemorrhagic pericardial effusion with tamponade in a patient in his late 30s with blunt chest trauma and multiple fractures who was anticoagulated with warfarin sodium but did not clinically manifest the effusion until 45 days after injury.