Unexpected PCE

If you only look for PCE when you expect it, you will probably miss some.

The first patient had some sort of unexplained febrile illness with a left shift and a creatinine of ~540 or so. Her IVC didn’t indicate marked hypovolemia. I looked at her heart to see the chamber function and found a small PCE. Not sure why it was there or why she was ill for that matter. Some weird viremia?

The second patient (same shift) was very elderly and came in with a history suggestive of Sciatica. I checked his aorta, kidneys, bladder, IVC and for no good reason, his heart. He had a moderately big PCE. Clinically he wasn’t in tamponade. Also I couldn’t find any physical evidence to suggest sciatica/hip pain or anything to explain his R “Sciatic” pain. I have no idea whether his PCE was related to the pain. The patient was admitted for observation.

[Ed. note.  With unexplained PCE’s lacking any infectious prodrome I routinely begin the search for a malignancy or autoimmune etiology.  Be sure to take a very careful history and find out if there has ever been a previous cancer.  I have found several undiagnosed new cancers and recurrences this way.]