Dear Sir,

I read with interest the article by Ravikirti et al in the recent edition of Acute Medicine. The authors rightly highlight the potential for atypical presentations of tamponade following cardiac surgery, which has been reported previously. The investigation of any acutely unwell patient presenting after cardiac surgery should include some form of cardiac imaging. In the cases described the diagnosis was delayed, in part, due to the lack of an echocardiography service out-of-hours.

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References

1. Ravikirti R, Rangaprasad K. Cardiac Tamponade: atypical presentations after cardiac surgery. Acute Medicine 2012; 11(2): 93-96.
2. Russo, AM, O’Connor WH, Waxman HL. Atypical presentations and echocardiography findings in patients with cardiac tamponade occurring early and late after cardiac surgery. Chest 1993; 104: 71-78.
3. Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. Radiographics 2007; 27(6): 1595-1610.
4. Restrepo CS, Gutierrez FR, Marmol-Velez JA, et al. Imaging patients with cardiac trauma. Radiographics 2012; 32(3): 633-649.
5. Sagrista-Sauleda J, Merce AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011; 26(3): 135-143.
6. Ionescu A, Wilde P, Karsch KR. Localized pericardial tamponade: Difficult echocardiographic diagnosis of a rare complication after cardiac surgery. J Am Soc Echocardiography 2001; 14(12): 1220-1223.
7. Vohra HA, Khout H, Bapu D, et al. Localised pericardial tamponade diagnosed by computed tomography: a case presentation. J Med Case Rep 2007; 1: 162.