Pyogenic Pericarditis Leading to Cardiac Arrest: a Case Report Highlighting POCUS-Guided Pericardiocentesis

A 44-year-old man with a history of intravenous drug use presented to the emergency department in cardiac arrest. Point of care ultrasound (POCUS) revealed a pericardial effusion with tamponade physiology. Initial landmark-guided pericardiocentesis returned blood but failed to confirm guidewire placement via POCUS. A repeat, ultrasound-guided pericardiocentesis yielded purulent fluid. Subsequent drainage of 50 mL of fluid improved cardiac contractility and hemodynamics. The patient was admitted to the intensive care unit, and pericardial fluid cultures grew Streptococcus pneumoniae. This case highlights the diagnostic and procedural utility of POCUS in managing purulent pericardial tamponade as a cause of cardiac arrest.