Pleuro-Pericardial Effusions Post Dual Chamber Permanent Pacemaker Placement

A 61 year old female with history of hypertension, coronary artery disease and sick sinus syndrome presented to emergency room for substernal chest discomfort, dyspnea and subjective low grade fever for one week. She denied significant cough or sputum production. She had dual chamber permanent pacemaker implantation through standard subclavian approach two weeks prior to the onset of symptoms. Physical examination showed temperature 98.5° F, blood pressure 105/62, heart rate 70, respiratory rate 16 and oxygen saturation 91% on ambient air. Chest auscultation revealed diminished breath sounds in bilateral lung bases and muffled heart sounds