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A not so typical pericardial effusion case…
  1. William R Miranda,
  2. Darrell B Newman,
  3. Rick A Nishimura
  1. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Rick A Nishimura, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; rnishimura{at}

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Clinical introduction

A 71-year-old woman with paroxysmal atrial fibrillation and hypothyroidism on hormone replacement presented with a 3-month history of progressive exertional dyspnoea and decline in functional capacity. She was evaluated and found to have a moderate circumferential pericardial effusion on transthoracic echocardiography without 2D or Doppler signs of tamponade physiology. Laboratory test showed normal thyroid-stimulating hormone and C-reactive protein levels, and sedimentation rate. Tuberculosis testing was negative and rheumatological panel was unrevealing. She was started on colchicine for idiopathic pericarditis. Due to progressive symptoms, she was referred to our institution for further evaluation. On …

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  • Correction notice Since the online publication of this image challenge the first line of the answer section has been updated.

  • Contributors WRM and DBN wrote the manuscript. RAN reviewed the paper as the senior author. All co-authors were involved in the patient's care.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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