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[Clinical Picture] Tension hydropneumopericardium after routine intubation

In June, 2014, a 37-year-old man with known end-stage renal disease and chronic uraemic pericardial effusion presented to our institution with gradually worsening dyspnoea and orthopnoea, 4 days after a nephrectomy to control hypertension. He had been having regular haemodialysis three-times per week for the preceding 9 years after rejection of a transplanted kidney. On examination he was severely dyspnoeic at rest, and had a pulse rate of 102 beats per min, respiratory rate of 20 breaths per min, and blood pressure 110/70 mm Hg with 25 mm Hg paradoxical changes.