Anamnese und klinischer Befund: Ein 23-jähriger Mann mit einem M. Hodgkin in Remission und einem bekanntem Protein C-Mangel präsentierte sich mit Thoraxschmerz und Zeichen eines respiratorischen Infektes.
Untersuchungen: Echokardiographisch zeigte sich ein purulenter Perikarderguss. Im Röntgen-Thorax demarkierte sich ein linksseitiges pneumonisches Infiltrat.
Therapie und Verlauf: Mittels Perikardiozentese konnte der Erguss nicht ausreichend drainiert werden. Die komplikationslose Sanierung gelang erst nach intraperikardialer Streptokinaseinstillation. Im weiteren Verlauf ergab sich eine Restitutio ad integrum.
Folgerung: Die intraperikardiale Fibrinolysetherapie scheint eine wirksame Therapiealternative bei purulenter Perikarditis darzustellen.
History and admission findings: A 23-year-old man known to have Hodgkin’s disease in remission and C-protein deficiency presented with chest pain and symptoms of respiratory infection.
Investigations: A purulent pericardial effusion was detected by echocardiography. The chest X-ray showed a left-sided pneumonia.
Treatment and clinical course: When pericardiocentesis failed to drain the purulent but pathogen-free effusion completely, streptokinase was several times instilled intrapericardially and achieved fibrinolysis without complication. The effusion did not recur.
Conclusions: Intrapericardial application of fibrinolytic agents seems to be an effective treatment of a purulent pericarditis.
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Dr. C. Zimmermann
Medizinische Klinik, Klinikum am Steinenberg, Akademisches Lehrkrankenhaus der Universität Tübingen
Steinenbergstraße 31
72764 Reutlingen
eMail: cdz932001@aol.com
