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Computed Tomography (CT) Guided Pericardiocentesis as First Line Treatment for Pericardial Effusion

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Computed Tomography (CT) Guided Pericardiocentesis

as First Line Treatment for Pericardial Effusion

D Portal1, A.D. Knoll2, E Gold3, A Vinzons4,

E Bonfils-Roberts4, J Arampulikan4, 

§Ultrasonography is a widely accepted imaging modality to facilitate pericardiocentesis by providing visual detection and treatment guidance.
§However, CT has the additional advantage over ultrasound of providing a broader field of view to readily distinguish adjacent disease processes that may simulate pericardial effusions on echocardiography.
§Additionally, CT has greater contrast resolution for visualization of the needle tip and is particularly advantageous for imaging the myocardial-pericardial interface.
§For the aforementioned reasons, CT has emerged as a preferred imaging modality in various interventions and procedures, with a continuously expanding list of possible clinical interventions.
§We present a case series to assess the technique and effectiveness of CT-guided pericardiocentesis, and to analyze its potential use as a first line treatment option for pericardial effusion.
 
§This retrospective study included all patients from 2012 onwards who presented with pericardial effusion and cardiac or pericardiac tamponade on echocardiography, for which CT-guided drainage intervention was performed at our institution.
§Procedure, demographic data, etiology of effusions, and complications were collected.
§Successful placement was confirmed by effective drainage and visualization of the catheter within the pericardial cavity on CT.
 
§Thirteen patients with echocardiographic evidence of pericardial effusions underwent CT-guided pericardiocenteses during the study interval.
§Etiologies attributed to the effusions included: malignancy (5/13), systemic lupus flare (3/13), and infectious process (5/13).
§The mean patient age was 57.5 years, and included six men and seven women. The body mass index (BMI) of patients averaged 26.7. Nine of these 13 patients (69.2%) were overweight or obese.
§A 19 gauge (12 of 13) or 21 gauge (1 of 13) needle was used to enter the pericardial sac via a left anterolateral approach.
§Drainage catheters were placed successfully in all patients (100%), aspirating an average of 375 mL of pericardial fluid. The pericardial fluid color was clear-yellow (8/13) or serosanguinous (5/13).
§One patient (1/13) experienced an immediate complication following the intervention, which consisted of a small asymptomatic left-sided pneumothorax which resolved spontaneously.
 
§CT provides an alternative method to plan and direct safe catheter placement for pericardiocentesis.
§While other modalities and approaches exist for the treatment of pericardial effusion, the comparative advantages and low risk profile of the CT guided approach should be strongly considered as a first-line treatment option.
§Finally, this treatment modality utilizes commonplace interventional radiology techniques and may be preferred for patients at high risk for traditional or surgical pericardiocentesis.

 

References:

1. Computed Tomography-guided Pericardiocentesis: Utility in the Management of Malignant Pericardial Effusion. Hoey, Edward T.D.; Mankad, Kshitij. The American Journal of Emergency Medicine (2010)

2. CT-guided Pericardiocenteses: Clinical Profile, Practice Patterns and Clinical Outcome. Eichlera, Katrin, et al. European Journal of Radiology. (2010)

3. Comparison of Surgical Pericardial Drainage with Percutaneous Catheter Drainage for Pericardial Effusion. Saltzman AJ, et al. Invasive Cardiol. (2012)

4. Salem K, Mulji A, Lonn E: Echocardiographically Guided Pericardiocentesis--the Gold Standard for Management of Pericardial Effusion and Cardiac Tamponade . Can J Cardiol (1999) 

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