Objective: A polytrauma patient with chest injury having incidentally detected asymptomatic pericardial effusion secondary to Hashimoto’s thyroiditis, masquerading as traumatic massive pericardial effusion with impending cardiac tamponade. Methods: We present the clinical features, biochemical and laboratory findings with Echocardiographic imaging data of the pericardial effusion for the current patient and review the clinical presentation, prevalence, pathophysiology, diagnosis, and treatment of pericardial effusion with impending tamponade. Results: A25 year-old man, not a known case of any co morbidity presented with polytrauma after an accident on construction site, with history of chest trauma. Patient was having severe sinus bradycardia for which echocardiography was advised. 2D echocardiography demonstrated a massive pericardial effusion and diastolic right atrial collapse suggestive of impending tamponade. An emergent pericardial window procedure via subxiphoid routewasperformed, and1000ml offluid was removed. The Non hemorrhagic fluid was sent for biochemical analysis which revealed exudative nature of the fluid. On evaluating the causes of Massive pericardial effusion, patient was found to have severe hypothyroidism with positive anti TPO antibodies. Levothyroxinetherapy was initiated. Patient was stable and discharged with satisfactory condition. Conclusion: From our review of the literature, we conclude that impending cardiac tamponade is a rare initial manifestation of autoimmune hypothyroidism. A high index of suspicion must be maintained for timely diagnosis of pericardial tamponade followed by prompt intervention. Recurrent pericardial effusions are common, necessitating close follow-up. Treatment of the hypothyroidism with levothyroxine is imperative.
