Successful Computed Tomography-guided Pericardiocentesis after Performing a Failed Conventional Transthoracic Echocardiography-guided Approach: A Case Report

Year 2020, , 39 - 42, 09.10.2020

Takashi Hongo , Hiroki Sugiyama Hiromichi Naito Atsunori Nakao

https://doi.org/10.33706/jemcr.632857

Cited By: 1

Abstract

Introduction: Computed tomography-guided pericardiocentesis has
been shown to be technically feasible and safe for treating pericardial
effusion. However, no recommendations for computed tomography-guided
pericardiocentesis have been made and standardized among the established
guidelines by the European Society of Cardiology or the Japanese Circulation
Society. We report on a case of successful computed tomography-guided
pericardiocentesis after performing a failed conventional transthoracic
echocardiography-guided approach in a patient with cardiac tamponade.

Case Report: A 71-year-old man was admitted to our hospital with
progressive chest discomfort and cardiac tamponade. Transthoracic
echocardiography-guided pericardiocentesis was primarily performed on the
patient; however, the quality of the transthoracic echocardiography images was
inadequate to guide the procedure, resulting in procedure-related pericardial
injury. When cardiac tamponade recurred, a computed tomography-guided approach
successfully treated the patient, with the success owed to precise intraoperative
visualization of the needle and organs.

Conclusion: Our case suggests that computed tomography guidance
is safe and useful in pericardiocentesis, especially for patients who are
ineligible to undergo an echo-guided approach.

Keywords

Pericardiocentesis, Computed Tomography

Supporting Institution

None

Project Number

None

Thanks

None

Successful Computed Tomography-guided Pericardiocentesis after Performing a Failed Conventional Transthoracic Echocardiography-guided Approach: A Case Report

Abstract

Introduction

Computed tomography-guided pericardiocentesis has been shown to be
technically feasible and safe for treating pericardial effusion. However, no
recommendations for computed tomography-guided pericardiocentesis have been
made and standardized among the established guidelines by the European Society of
Cardiology or the Japanese Circulation Society. We report on a case of
successful computed tomography-guided pericardiocentesis after performing a
failed conventional transthoracic echocardiography-guided approach in a patient
with cardiac tamponade.

Case Report

A 71-year-old man was admitted to our hospital with progressive
chest discomfort and cardiac tamponade. Transthoracic echocardiography-guided
pericardiocentesis was primarily performed on the patient; however, the quality
of the transthoracic echocardiography images was inadequate to guide the
procedure, resulting in procedure-related pericardial injury. When cardiac
tamponade recurred, a computed tomography-guided approach successfully treated
the patient, with the success owed to precise intraoperative visualization of
the needle and organs.

Conclusion

Our case suggests that computed tomography guidance is safe and
useful in pericardiocentesis, especially for patients who are ineligible to
undergo an echo-guided approach.

Keywords

pericardiocentesis, computed tomography

Project Number

None

References

• References1. Nour-Eldin NA, Alsubhi M, Gruber-Rouh T, et al. CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery. Cardiovasc Intervent Radiol 2017;40:1223-1228.2. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015;36:2921-2964.3. Tsutui CH. Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure (JCS 2017/JHFS 2017). 2018.4. Bruning R, Muehlstaedt M, Becker C, Knez A, Haberl R, Reiser M. Computed tomography-fluoroscopy guided drainage of pericardial effusions: experience in 11 cases. Invest Radiol. 2002;37:328-332.5. Neves D, Silva G, Morais G, et al. Computed tomography-guided pericardiocentesis - A single-center experience. Rev Port Cardiol 2016;35:285-290.6. Virk SA, Chandrakumar D, Villanueva C, Wolfenden H, Liou K, Cao C. Systematic review of percutaneous interventions for malignant pericardial effusion. Heart 2015;101:1619-1626.7. Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002;77:429-436.8. Cooper JP, Oliver RM, Currie P, Walker JM, Swanton RH. How do the clinical findings in patients with pericardial effusions influence the success of aspiration? Br Heart J 1995;73:351-354.9. Chandraratna PA, Mohar DS, Sidarous PF. Role of echocardiography in the treatment of cardiac tamponade. Echocardiography 2014;31:899-910.10. Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. Radiographics 2007;27:1595-1610.