Pericardiocentesis: ultrasound guidance is essential

Abstract

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.

Tension pneumopericardium in blunt multi‐system trauma in a resource limited setting

“…Multiple studies and expert opinions have indicated decreased mortality and morbidity of pericardiocentesis with ultrasound guidance. 5 In the setting of extensive pneumopericardium and subcutaneous emphysema, ultrasound guidance may prove difficult. This may be due in part to the difficulty of discerning the air‐filled pericardium from pulmonary tissue, as well as the acuity of the condition.…”

“…In general, ultrasound‐guided pericardiocentesis is preferred over landmark‐guided methods. Multiple studies and expert opinions have indicated decreased mortality and morbidity of pericardiocentesis with ultrasound guidance 5 . In the setting of extensive pneumopericardium and subcutaneous emphysema, ultrasound guidance may prove difficult.…”

Off-plane technique ultrasound-guided pericardiocentesis via anterior approach: short communication

“…Pericardial effusion is defined as the abnormal accumulation of fluid in the pericardial cavity, which can develop due to overproduction of pericardial fluid, decreased reabsorption, or an imbalance between the hydrostatic and oncotic pressures of the fluid [ 3 ]. There are multiple causes for the development of pericardial effusion such as heart failure, trauma, neoplasms, infections, connective tissue diseases, and metabolic disorders [ 4 ].…”

“…

the hydrostatic and oncotic pressures of the fluid [3]. There are multiple causes for the development of pericardial effusion such as heart failure, trauma, neoplasms, infections, connective tissue diseases, and metabolic disorders [4].Pericardial effusion, depending on its volume and time of onset, can lead to increased intrapericardial pressures transmitted to the cardiac cavities, leading to hemodynamic alterations and in severe cases, being associated with shock, a condition known as cardiac tamponade [5,6]. The diagnosis of pericardial effusion is clinical, supported by echocardiographic findings suggesting alterations in intracardiac filling pressures.

…”

A rare case of hepatic vein puncture during attempted pericardiocentesis mimicking right atrium perforation

“…1 Currently, ultrasound-guided pericardiocentesis is the recommended practice for hemodynamically significant pericardial effusion. 2 Reported procedural morbidity and mortality associated with pericardiocentesis are 1-3% and 1% respectively. 3 Cardiac chamber perforation is one of the most feared complications of pericardiocentesis.…”