[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-413068-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-413068-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","localized-reaccumulation-of-pericardial-effusion-after-pericardial-fenestration-undetected-on-frontal-chest-radiography","Localized Reaccumulation of Pericardial Effusion After Pericardial Fenestration Undetected on Frontal Chest Radiography","","A 70-year-old man with advanced lung adenocarcinoma presented with dyspnea and was diagnosed with cardiac tamponade, requiring pericardial drainage. Pericardial effusion reaccumulated after 73 days, leading to right pericardial fenestration. Respiratory status deteriorated progressively three weeks postoperatively, while frontal chest radiography showed little change. Autopsy CT demonstrated heterogeneously reaccumulated, loculated effusion in the pericardial cavity, attributed to adhesions. The case highlights that worsening after fenestration may warrant lateral imaging, echocardiography, and chest CT.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/localized-reaccumulation-of-pericardial-effusion-after-pericardial-fenestration-undetected-on-frontal-chest-radiography/413068/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/localized-reaccumulation-of-pericardial-effusion-after-pericardial-fenestration-undetected-on-frontal-chest-radiography/413068.png","ImageObject",300,407,{"name":42,"@type":43},"jayni","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What caused the patient’s pericardial effusion recurrence after pericardial fenestration?","Question",{"text":63,"@type":64},"Autopsy revealed adhesions around the fenestration site, with pericardial effusion reaccumulating in a heterogeneous, loculated pattern in the pericardial cavity.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why was the recurrence not detected on frontal chest radiography?",{"text":68,"@type":64},"The reaccumulated effusion was heterogeneously distributed and septated in the pericardial spaces, making it difficult to visualize on frontal chest X-ray.",{"name":70,"@type":61,"acceptedAnswer":71},"What additional evaluations were recommended when respiratory status worsens after fenestration?",{"text":72,"@type":64},"Lateral imaging, echocardiography, and chest CT should be considered to detect recurrent effusion not seen on frontal radiography.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},413068,1790717264,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":97,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},3985747859343,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Review began 10/04/2025  \nReview ended 11/30/2025  \nPublished 12/02/2025  \n© Copyright 2025  \nKobayashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98311  \nOpen Access Case Report  \nLocalized Reaccumulation of Pericardial Effusion After Pericardial Fenestration Undetected on Frontal Chest Radiography  \nChihiro Kobayashi 1, Shintaro Shimizu 1 , Amano Yoshihiro 1, Kashu Kitani 1 , Takeshi Isobe 1 , Tamio Okimoto 1  \n1. Division of Medical Oncology 􀀀 Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, JPN  \nCorresponding author: Tamio Okimoto, [okimoto@med.shimane-u.ac.jp](okimoto@med.shimane-u.ac.jp)  \nAbstract  \nA 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.  \nCategories: Oncology, Pulmonology  \nKeywords: cardiac tamponade, chest x-ray, echocardiogram, pericardial effusion, pericardial fenestration  \nIntroduction  \nPericardial effusion can result from various etiologies. Contemporary hospital cohorts show a shift toward iatrogenic complications, with malignancy, infectious/inflammatory disease, and mechanical cardiac events remaining important contributors [1,2] . Iatrogenic complications were associated with a relatively better outcome compared to tamponade induced by malignant diseases [1,2] . The therapeutic goals in pericardial tamponade are rapid hemodynamic stabilization and long-term prevention of fluid reaccumulation.  \nAlthough Japanese guidelines for lung cancer weakly recommend pericardial sclerosis, pericardial  \nfenestration is not explicitly endorsed owing to the lack of prospective data [3] . In contrast, a systematic review of malignant effusions demonstrated superior symptom relief and lower recurrence rates with surgical drainage compared with non-surgical modalities, with overall success rates of 93.3-100% and  \ncomplication rates of 4 .5-10.3%[4] .  \nHistorically, recurrence after fenestration has been regarded as relatively uncommon, with reported rates of approximately 10%[5] . However, the true incidence and underlying mechanisms remain uncertain. Here, wereport a case of localized, loculated pericardial effusion after fenestration caused by adhesions at the fenestration site. Notably, the recurrence was not detectable on frontal chest radiography but was identified only by postmortem CT and autopsy.  \nCase Presentation  \nA 70-year-old man with advanced lung adenocarcinoma presented with a one-week history of dyspnea. On admission, he was hypotensive and tachycardic. Echocardiography revealed a large circumferential  \npericardial effusion, consistent with cardiac tamponade, and urgent pericardial drainage was performed (Figures 1A, 1B) . Cytological analysis of pericardial fluid was positive for adenocarcinoma, confirming malignant pericardial effusion. He was referred to our hospital for further investigation and treatment. He was initiated on a combination chemotherapy of carboplatin and ","cbCaieKA0TNmTCej","https://ap.wps.com/l/cbCaieKA0TNmTCej","pdf",2445295,"English","# Abstract\n# Introduction\n# Case Presentation\n# How to cite this article\n# Figures and findings","[{\"question\":\"What caused the patient’s pericardial effusion recurrence after pericardial fenestration?\",\"answer\":\"Autopsy revealed adhesions around the fenestration site, with pericardial effusion reaccumulating in a heterogeneous, loculated pattern in the pericardial cavity.\"},{\"question\":\"Why was the recurrence not detected on frontal chest radiography?\",\"answer\":\"The reaccumulated effusion was heterogeneously distributed and septated in the pericardial spaces, making it difficult to visualize on frontal chest X-ray.\"},{\"question\":\"What additional evaluations were recommended when respiratory status worsens after fenestration?\",\"answer\":\"Lateral imaging, echocardiography, and chest CT should be considered to detect recurrent effusion not seen on frontal radiography.\"}]","Localized Reaccumulation of Pericardial Effusion After Pericardial Fenestration Undetected on Frontal Chest Radiography | PDF",1790593666,13]