Idiopathic Pericardial Tamponade in the Absence of Predisposing Factors: A Diagnostic Conundrum and Therapeutic Approach

Pericardial effusion, while not uncommon, poses significant diagnostic and therapeutic challenges, particularly when presenting as tamponade, especially in young individuals without identifiable risk factors. We present a compelling case of a 19-year-old with acute dyspnea ultimately diagnosed with idiopathic pericardial tamponade. Despite a comprehensive evaluation ruling out infectious, neoplastic, and autoimmune etiologies, the underlying cause remained elusive. Urgent intervention via ultrasound-guided pericardiocentesis revealed hemorrhagic fluid, underscoring the critical role of timely management. Treatment with aspirin and colchicine resulted in symptom resolution, highlighting the efficacy of this therapeutic approach. Long-term follow-up demonstrated no recurrence, emphasizing the favorable prognosis associated with conservative management. This case underscores the importance of a systematic diagnostic approach and the need for further research to elucidate the pathophysiology and refine treatment strategies for this perplexing condition.