Recurrent purulent cardiac tamponade caused by rupture of an anterior mediastinal teratoma: a case report.

Mediastinal teratomas are rare germ cell tumors that may present with acute complications, such as rupture, resulting in purulent pericardial effusion and cardiac tamponade. Prompt recognition and intervention are essential to prevent life-threatening deterioration. A 21-year-old previously healthy man presented with acute severe chest pain, dyspnea, and dry cough. Initial chest computed tomography (CT) revealed a 9 × 7 cm anterior mediastinal mass suggestive of teratoma, with minimal pericardial effusion confirmed by echocardiography. Vital signs indicated tachycardia and tachypnea, accompanied by leukocytosis but normal cardiac markers. Within 16 h, the patient developed fever, hypotension, hypoxemia, and oliguria, progressing to septic shock. Bedside ultrasound revealed a large pericardial effusion with signs of tamponade, leading to urgent ultrasound-guided pericardiocentesis that drained purulent fluid. Tumor aspiration confirmed rupture into the pericardial sac, yielding similar purulent material containing hair and fatty globules. Hemodynamic stabilization followed, but the effusion reaccumulated by day 7, requiring repeat pericardiocentesis via a left lateral approach. On hospital day 30, surgical resection revealed a fistula connecting the mass to the pericardium, along with intraoperative findings of pus, hair, sebum, and adhesions. Pathology confirmed a mixed germ cell tumor (predominantly mature teratoma with 5% seminoma). No adjuvant therapy was required. This case highlights the rare yet fulminant complication of mediastinal teratoma rupture leading to purulent pericarditis and tamponade. Bedside ultrasound-guided interventions were pivotal in management, emphasizing the importance of serial monitoring and multidisciplinary care. At 14-month follow-up, the patient remained free of metastasis.