Heart World Conference 2026

Abstract

Massive pericardial effusion typically presents with cardiopulmonary symptoms and may progress to life-threatening cardiac tamponade. However, slow accumulation of pericardial fluid can occasionally result in tamponade physiology without overt clinical manifestations. We present a rare case of an asymptomatic massive pericardial effusion with tamponade physiology in a patient with Fahr’s syndrome secondary to hypoparathyroidism. A 57-year-old female with a history of seizures and a remote partial thyroidectomy presented with recurrent generalized tonic-clonic seizures, visual hallucinations, disorientation, insomnia, and carpal spasms. Physical examination revealed positive Chvostek and Trousseau signs suggestive of symptomatic hypocalcemia. Cranial computed tomography demonstrated bilateral symmetrical calcifications involving the caudate nuclei, globus pallidus, periventricular white matter, and dentate nuclei, consistent with Fahr’s syndrome. Laboratory evaluation showed severe hypocalcemia (0.73–0.85 mmol/L), hyperphosphatemia (2.30 mmol/L), hypomagnesemia (0.71 mmol/L), vitamin D deficiency (5.0 ng/mL), and markedly suppressed parathyroid hormone levels (<4.0 pg/mL), confirming hypoparathyroidism. Despite the absence of chest pain, dyspnea, hypotension, jugular venous distention, muffled heart sounds, or pulsus paradoxus, chest radiography revealed a markedly enlarged cardiac silhouette with a water-bottle configuration suggestive of pericardial effusion. Transthoracic echocardiography demonstrated a massive circumferential pericardial effusion measuring up to 3.2 cm with right atrial collapse, consistent with tamponade physiology. Electrolyte abnormalities were corrected, and seizure management was optimized. Urgent pericardiostomy was recommended, but declined because of financial constraints. This case highlights an unusual cardiovascular manifestation of chronic hypocalcemia secondary to hypoparathyroidism. More importantly, it demonstrates that echocardiographic tamponade physiology may exist despite the absence of overt clinical tamponade. Clinicians should maintain a high index of suspicion for occult cardiovascular involvement in patients with endocrine disorders, as potentially life-threatening cardiac complications may remain clinically silent