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Cardiology Clinics Nov 2017The normal pericardial sac contains up to 50 mL of fluid, which consists of a plasma ultrafiltrate. Anything greater constitutes a pathologic effusion. The curvilinear... (Review)
Review
The normal pericardial sac contains up to 50 mL of fluid, which consists of a plasma ultrafiltrate. Anything greater constitutes a pathologic effusion. The curvilinear pressure-volume relationship of the pericardial sac dictates hemodynamic consequences of a pericardial effusion and is responsible for rapidly accumulating fluid that causes cardiac tamponade. A variety of diseases and complications cause pericardial effusion. The most common are idiopathic pericarditis, cancer, connective tissue disorders, and hemorrhage. Management of pericardial effusion is dictated by whether tamponade is present or threatened. If it is, urgent/emergent pericardiocentesis is indicated. If not, a systematic approach to diagnosis and management should be undertaken.
Topics: Bacterial Infections; Cardiac Tamponade; Echocardiography; Electrocardiography; Heart Neoplasms; Hemorrhage; Humans; Magnetic Resonance Imaging; Pericardial Effusion; Pericardial Fluid; Pericardiocentesis; Pericarditis; Radiography, Thoracic; Renal Insufficiency, Chronic; Tomography, X-Ray Computed
PubMed: 29025543
DOI: 10.1016/j.ccl.2017.07.005 -
Current Cardiology Reports Nov 2023The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current... (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage.
RECENT FINDINGS
Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.
Topics: Humans; Pericardiocentesis; Pericardial Effusion; Echocardiography; Drainage; Tomography, X-Ray Computed
PubMed: 37856032
DOI: 10.1007/s11886-023-01965-9 -
Current Cardiology Reports Mar 2016The space that exists between the visceral and parietal pericardium has a small amount of fluid under physiologic conditions. The pericardial layers and this fluid in... (Review)
Review
The space that exists between the visceral and parietal pericardium has a small amount of fluid under physiologic conditions. The pericardial layers and this fluid in combination have a protective role and also offer fluidity of motion and shock absorbance. The pericardium and the fluid can often be involved in pathologies involving the myocardium or sometimes be independently involved in primary diseases of the pericardium with secondary hemodynamic effects. In physiologic and pathologic conditions, invasion of this space by surgical and percutaneous interventions can provide a unique and precious opportunity to enhance patient management in such situations from a diagnostic and therapeutic aspect. This field of "interventional pericardiology" is the focus of this chapter.
Topics: Cardiomyopathies; Catheter Ablation; Epicardial Mapping; Fluoroscopy; Humans; Pericardial Window Techniques; Pericardiocentesis; Pericardium; Radiography, Interventional; Ultrasonography, Interventional
PubMed: 26908116
DOI: 10.1007/s11886-016-0698-9 -
Journal of Cardiothoracic and Vascular... Jan 2020
Topics: Anesthesiologists; Humans; Internship and Residency; Pericardiocentesis; Ultrasonography; Ultrasonography, Interventional
PubMed: 31837739
DOI: 10.1053/j.jvca.2019.11.030 -
The American Journal of the Medical... Nov 2022Pericardial fistula is a rare complication. Generally, the diagnosis can be confirmed by imaging examination, but our patient was an exception. We present a 71-year-old... (Review)
Review
Pericardial fistula is a rare complication. Generally, the diagnosis can be confirmed by imaging examination, but our patient was an exception. We present a 71-year-old female patient that complained of remnant gastric cancer for five months and dyspnea for seven days; the dyspnea became aggravated during the last two days. After admission, emergency thoracic computed tomography and echocardiography showed pericardial effusion, and pericardiocentesis was performed. After conventional treatment, the pericardial effusion was unchanged and no cancer cells were found in the pericardial drainage. However, the color changed from turbid to golden yellow and, finally, to green. After 20 days of repeated laboratory, imaging, and gastrointestinal contrast examinations, no cause was found. Moreover, a clinical diagnosis could not be obtained following numerous comprehensive clinical analyses. Given the color change of the pericardial drainage, we strongly suspected pericardial fistula, but the imaging examinations were negative. Finally, a methylene blue test confirmed the existence of a pericardial fistula. When the color of the pericardial effusion changes, the existence of a pericardial fistula must be considered in advance, and other methods should be evaluated if imaging cannot assist in the diagnosis.
Topics: Humans; Female; Aged; Pericardial Effusion; Methylene Blue; Pericardiocentesis; Fistula; Dyspnea; Cardiac Tamponade
PubMed: 35718121
DOI: 10.1016/j.amjms.2022.06.008 -
Current Cardiology Reports Jun 2020Abnormal accumulation of pericardial fluid is a common cardiac condition with different etiologies. Draining of the pericardial fluid (pericardiocentesis) is often... (Review)
Review
PURPOSE OF REVIEW
Abnormal accumulation of pericardial fluid is a common cardiac condition with different etiologies. Draining of the pericardial fluid (pericardiocentesis) is often indicated for diagnostic and therapeutic purposes and is performed in an elective or emergent setting. Echocardiography is the primary imaging method for diagnosing, localizing, and quantifying pericardial effusion as well as evaluating its hemodynamic effects, including the presence of cardiac tamponade. In this manuscript, we review the indications for pericardiocentesis and provide practical step-by-step guidance for echo-guided pericardiocentesis.
RECENT FINDINGS
Echo-guidance is an effective method to improve the safety and efficacy of pericardiocentesis. In experienced hands and with a stepwise approach, procedural outcomes are excellent, and complication rates are very low. Asymptomatic small idiopathic effusions have a benign course and can be left untreated. Prolonged drainage with an indwelling pericardial catheter is key for preventing fluid re-accumulation, and the use of colchicine to prevent fluid recurrence is encouraged whenever possible. Understanding how to evaluate the significance of a pericardial effusion as well as the procedural steps in the performance of a pericardiocentesis are essential for optimal outcomes in treating patients with pericardial effusions and tamponade.
Topics: Cardiac Tamponade; Drainage; Echocardiography; Humans; Pericardial Effusion; Pericardiocentesis
PubMed: 32572594
DOI: 10.1007/s11886-020-01320-2 -
Cardiology Clinics Nov 2017Effusive-constrictive pericarditis (ECP) corresponds to the coexistence of a hemodynamically significant pericardial effusion and decreased pericardial compliance. The... (Review)
Review
Effusive-constrictive pericarditis (ECP) corresponds to the coexistence of a hemodynamically significant pericardial effusion and decreased pericardial compliance. The hallmark of ECP is the persistence of elevated right atrial pressure postpericardiocentesis. The prevalence of ECP seems higher in tuberculous pericarditis and lower in idiopathic cases. The diagnosis of ECP is traditionally based on invasive hemodynamics but the presence of echocardiographic features of constrictive pericarditis post-pericardiocentesisis can also identify ECP. Data on the prognosis and optimal treatment of ECP are still limited. Anti-inflammatory agents should be the first line of treatment. Pericardiectomy should be reserved for refractory cases.
Topics: Anti-Inflammatory Agents; Atrial Pressure; Echocardiography; Hemodynamics; Humans; Pericardial Effusion; Pericardiectomy; Pericardiocentesis; Pericarditis, Constrictive; Pericarditis, Tuberculous; Prognosis
PubMed: 29025546
DOI: 10.1016/j.ccl.2017.07.008 -
The American Journal of Emergency... Mar 2018Pericardial effusion of various sizes is a quite common clinical finding, while its progression to effusive-constrictive pericarditis occurs in about 1.4-14% of cases....
Pericardial effusion of various sizes is a quite common clinical finding, while its progression to effusive-constrictive pericarditis occurs in about 1.4-14% of cases. Although available evidence on prevalence and prognosis of this rare pericardial syndrome is poor, apparently a considerable proportion of patients conservatively managed has a spontaneous resolution after several weeks. A 61-year-old female presented to our emergency department reporting fatigue, effort dyspnea and abdominal swelling. The echocardiography showed large pericardial effusion with initial hemodynamic impact, so she underwent a pericardiocentesis with drainage of 800-850cm of exudative fluid, on which diagnostic investigations were undertaken: possible viral and bacterial infections, medical conditions, iatrogenic causes, neoplastic and connective tissue diseases were all excluded. Despite empirical therapy with NSAIDs and colchicine, after about one week she had a recurrence of pericardial effusion and progressive development of constriction. Echocardiography performed after a few weeks of anti-inflammatory therapy showed resolution of constriction and PE, with clinical improvement. If progression of pericardial syndromes to a constrictive form is rarely described in literature, cases of transitory effusive-constrictive phase are even more uncommon, mainly reported during the evolution of pericardial effusion. According to the available data, risk of progression to a constrictive form is very low in case of idiopathic pericardial effusion. We report a case of large idiopathic subacute pericardial effusion, treated with pericardiocentesis and then evolved into an effusive-constrictive pericarditis. A prolonged anti-inflammatory treatment leads to complete resolution of pericardial syndrome without necessity of pericardiectomy.
Topics: Echocardiography; Emergency Service, Hospital; Female; Humans; Middle Aged; Pericardial Effusion; Pericardiocentesis; Pericarditis, Constrictive
PubMed: 29169889
DOI: 10.1016/j.ajem.2017.11.047 -
Trends in Cardiovascular Medicine Oct 2019Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical... (Review)
Review
Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.
Topics: Drainage; Humans; Pericardial Effusion; Pericardiocentesis; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 30482483
DOI: 10.1016/j.tcm.2018.10.016 -
The New England Journal of Medicine May 2018
Topics: Adult; Echocardiography; Female; HIV; Humans; Mycobacterium tuberculosis; Pericardial Effusion; Pericardiocentesis; Pericarditis, Tuberculous
PubMed: 29768154
DOI: 10.1056/NEJMicm1709552