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UPO: unidentified pericardial object

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A 54 year old woman was admitted to our hospital because of severe chest pain and progressive dyspnoea. Physical examination revealed hypotension, elevated central venous pressure, and a loud triphasic myocardial friction rub. Echocardiography showed a large amount of pericardial fluid compressing the heart and a round structure freely floating in the pericardial fluid. The apex of the heart moved the mass like the nose of a seal that plays a ball. Because of haemodynamic failure lateral thoracotomy with partial pericardiectomy was performed. About 700 ml of fluid and the unidentified pericardial object were removed. Histopathological examination revealed signs of an aspecific chronic fibrinous exudative pericarditis, and the structure was pure fibrin in origin. Cultures and serological study yielded no evidence of a causative organism. The patient made a quick and full recovery and returned to work.