Introduction
Purulent pericarditis (PP) is a devastating condition with a high mortality rate of around 40% even after appropriate medical and surgical treatment.[1, 2] Surgical pericardiectomy can prevent progression to the feared long-term complication of constrictive pericarditis but carries high mortality of nearly 8%.[3] Intrapericardial administration of a fibrinolytic agent (IFA) such as urokinase has been shown to be effective in preventing constriction in one randomized clinical trial.[4] A decrease in fibrin content which is commonly associated with infection with a consequent decrease in pericardial fibrosis is the suggested mechanism for a decrease in the incidence of pericardial constriction following IFA.[5, 6] Because of this, IFA has been recommended by some in the management of PP.[7, 8] In this report, we present an adult patient with PP in whom two-dimensional transthoracic echocardiography (2DTTE) demonstrated a marked decrease in the area of the right ventricular (RV) wall together with the overlying fibrin following IFA as compared to the baseline. These 2DTTE findings are consistent with a substantial decrease in fibrin content following IFA. To the best of our knowledge, these findings have not been documented before with illustrations of both pre and post IFA 2DTTE measurements in an adult with PP.