Focused cage-side ultrasonography was performed on the abdomen and thorax. A large amount of both free abdominal fluid and pericardial effusion was identified. There was also evidence of cardiac tamponade.
A peripheral catheter was placed for fluid, and possible lidocaine, administration. Pericardiocentesis was performed, and 450 mL of serosanguineous fluid was removed. Fluid packed cell volume was 11% and total solids was 2.3 mg/dL compared with peripheral blood packed cell volume of 43% and total solids of 8.2 mg/dL. Bentley did well during pericardiocentesis but remained uncomfortable.
Abdominocentesis was then performed, and 3.1 L of serosanguineous fluid was removed. Bentley was visibly more comfortable afterward and slept the rest of the day while being monitored for increases in heart rate or unusual behavior. His heart rate was 40 to 60 bpm while he was asleep and 100 to 120 bpm when he was awake.
Bentley was hospitalized for 24 hours, and a recheck thoracic-focused assessment with sonography for trauma was performed to ensure there was no further fluid accumulation. He was discharged the next day, and a full cardiac evaluation was scheduled for the 2-week recheck.
At the recheck, there was recurrent pericardial effusion without evidence of tamponade; no masses were visualized. Repeat pericardiocentesis was performed at that time and 2 months later, at which time a pericardiectomy was also performed to prevent further episodes of tamponade. Histopathologic evaluation of the pericardium showed changes consistent with chronic inflammation and mesothelial proliferation.