-
Annals of Medicine and Surgery (2012) Aug 2022The hemodynamic stability of the heart and pericardium are maintained by the pericardial fluid of volume ∼10-50 ml. Pericardial effusion is associated with the... (Review)
Review
The hemodynamic stability of the heart and pericardium are maintained by the pericardial fluid of volume ∼10-50 ml. Pericardial effusion is associated with the abnormal accumulation of pericardial fluid in the pericardial cavity. Numerous imaging techniques are utilized to evaluate pericardial effusion including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis. Once diagnosed, there are numerous treatment options available for the management of patients with pericardial effusion. These include various invasive and non-invasive strategies such as pericardiocentesis, pericardial window, and sclerosing therapies. In recent times, few studies have been conducted to evaluate the safety and efficacy of each approach in routine clinical practice. In this review, we review the role of different modalities in the diagnosis of pericardial effusion while highlighting existing therapies aimed at the management and treatment of pericardial effusion.
PubMed: 35846853
DOI: 10.1016/j.amsu.2022.104142 -
The Ultrasound Journal Feb 2022Pericardial effusion is a common entity which may have important implications in patient's prognosis. In several cases, pericardiocentesis is indicated for diagnostic...
BACKGROUND
Pericardial effusion is a common entity which may have important implications in patient's prognosis. In several cases, pericardiocentesis is indicated for diagnostic and/or therapeutic purposes.
CASE PRESENTATION
A blind pericardiocentesis failed in a 95-year-old woman admitted to the emergency department with a large pericardial effusion incidentally diagnosed in the ambulatory setting. Ultrasound-guided pericardiocentesis aided in easily accessing to the pericardial cavity, without periprocedural complications.
CONCLUSIONS
Ultrasound-guided pericardiocentesis is simple, safe and effective, and should replace the blind technique. This procedure should be part of the armamentarium of ultrasound-guided practices of emergency or critical care physicians.
PubMed: 35157176
DOI: 10.1186/s13089-022-00259-5 -
JACC. Case Reports Jan 2023
PubMed: 36636510
DOI: 10.1016/j.jaccas.2022.101699 -
JACC. Cardiovascular Imaging Apr 2018
Topics: Echocardiography; Humans; Incidence; Pericardial Effusion; Pericardiocentesis; Pericarditis, Constrictive
PubMed: 29622178
DOI: 10.1016/j.jcmg.2017.10.028 -
Frontiers in Cardiovascular Medicine 2021Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the...
Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the management of malignancy-related pericardial effusion in patients with thrombocytopenia. Our study aimed to analyze prognostic factors and overall survival (OS) after pericardiocentesis in thrombocytopenic cancer patients. A retrospective review of 136 thrombocytopenic cancer patients who underwent primary percutaneous pericardiocentesis was performed. Degree of thrombocytopenia was classified by platelet count recorded on day of pericardiocentesis: 75-149 × 10 cells/μL (41%); 50-74 × 10 cells/μL (10%); 25-49 × 10 cells/μL (24%); <25 × 10 cells/μL (25%). Median OS was 2.6 months and median follow-up was 37.4 months. Kaplan-Meier survival analysis showed significant OS differences among thrombocytopenia severity groups ( = 0.023), and worse OS with platelets <100 vs. ≥100 × 10 cells/μL ( = 0.031). By univariate analysis, thrombocytopenia severity was associated with increased risk of death (HR 0.993; 95% CI 0.989-0.997; = 0.002). Poor prognostic factors for OS were advanced cancer, malignant effusion, elevated international normalized ratio (INR), quantity of platelet transfusions, and platelet transfusion resistance. However, thrombocytopenia severity became insignificant for OS ( = 0.802), after adjusting for advanced cancer and INR. For patients with malignancy-related large pericardial effusion and thrombocytopenia, pericardiocentesis is a feasible intervention and should be considered due to low complication rates. There is no absolute contraindication to pericardiocentesis in case of hemodynamic instability, even with severe thrombocytopenia.
PubMed: 33969007
DOI: 10.3389/fcvm.2021.638943 -
BMJ Case Reports Jan 2021We report a case of a 42-year-old man who presented with acute epigastric and retrosternal chest pain and exertional dyspnoea, and was subsequently diagnosed with...
We report a case of a 42-year-old man who presented with acute epigastric and retrosternal chest pain and exertional dyspnoea, and was subsequently diagnosed with polyserositis secondary to post- infection. A CT scan showed a large pericardial effusion requiring pericardiocentesis, small bilateral pleural effusions and small amount of ascites. Several serological tests were done, which were all found to be normal. Pericardial and pleural fluid aspirates revealed an exudate. Culture of the pleural fluid yielded growth of and this was deemed the cause of the polyserositis, which is rare. The patient made a spontaneous recovery. He was started on colchicine by the cardiologists to help prevent pericardial fluid recurrence and this was continued for 3 months. A dental review confirmed the presence of dental caries, the possible source of infection. On follow-up, the patient remained well with no further relapses.
Topics: Adult; Anti-Inflammatory Agents; Ascites; Colchicine; Humans; Male; Pericardial Effusion; Pericardiocentesis; Pleural Effusion; Serositis; Streptococcal Infections; Streptococcus mitis; Tomography, X-Ray Computed
PubMed: 33472801
DOI: 10.1136/bcr-2020-236704 -
Pneumologie (Stuttgart, Germany) Oct 2019
Topics: Drainage; Humans; Pericardiocentesis; Pericardium; Practice Guidelines as Topic; Punctures
PubMed: 31622998
DOI: 10.1055/a-0863-8903 -
Texas Heart Institute Journal Dec 2023Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed for a posteriorly located effusion not amenable to transthoracic drainage in a...
Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed for a posteriorly located effusion not amenable to transthoracic drainage in a 58-year-old woman with a history of recurrent breast adenocarcinoma who presented with dyspnea. The patient had a pericardial effusion that resulted in cardiac tamponade. Transthoracic pericardiocentesis was unsuitable because of the posterior location of the effusion. Pericardiocentesis via the transesophageal route was performed. The pericardial sac was punctured with a 19-gauge needle, and 245 mL of pericardial fluid were aspirated, resulting in the resolution of the tamponade physiology. Endoscopic ultrasonography-guided transesophageal drainage is a novel and promising therapeutic option for posteriorly located pericardial effusions.
Topics: Female; Humans; Middle Aged; Pericardial Effusion; Pericardiocentesis; Cardiac Tamponade; Pericardium; Needles
PubMed: 38087478
DOI: 10.14503/THIJ-23-8230 -
The Western Journal of Emergency... Jul 2021Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during...
INTRODUCTION
Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models.
METHODS
Residents watched a 20-minute video about performing a pericardiocentesis and practiced both a blind and ultrasound-guided technique. We assessed model fidelity, convenience, and perceived provider competence via post-workshop questionnaire.
RESULTS
A total of 24/26 (93%) individuals practicing on the ultrasound-guided model and 22/24 (92%) on the blind approach model agreed or strongly agreed that the models reasonably mimicked a pericardial effusion.
CONCLUSION
Our low-cost, low-fidelity model is durable, mimics the clinical case, and is easy to use. It also addresses known limitations from prior low-fidelity models.
Topics: COVID-19; Emergency Medicine; Humans; Internship and Residency; Pericardiocentesis; Ultrasonography
PubMed: 35354017
DOI: 10.5811/westjem.2021.3.49876 -
Journal of Cardiovascular Ultrasound Dec 2016Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial...
BACKGROUND
Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP.
METHODS
Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction.
RESULTS
Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively.
CONCLUSION
Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
PubMed: 28090260
DOI: 10.4250/jcu.2016.24.4.317