Loculated Pericardial Effusion Successfully Managed With Right

Loculated Pericardial Effusion Successfully Managed With Right

Loculated Pericardial Effusion Successfully Managed With Right Parasternal Pericardiocentesis
Loküle Perikardiyal Effüzyonun Sağ Parasternal Perikardiosentez ile Başarılı Tedavisi
Uzm. Dr. Mustafa Adem Tatlısu1, Uzm. Dr. Emrah Bozbeyoğlu2, Uzm. Dr. Bülent Aydemir3, Prof. Dr.
Zekeriya Nurkalem4
1 Sivas Numune Hastanesi, Kardiyoloji Kliniği, Sivas, Türkiye
2 İstanbul Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji
Kliniği, İstanbul, Türkiye
3 İstanbul Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Cerrahisi
Kliniği, İstanbul, Türkiye
4 İstanbul Medipol Üniversitesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkıye
Anahtar Kelimeler: Perikardiyosentez, parasternal yaklaşım, loküle perikardiyal effüzyon
Keywords: Pericardiocentesis, parasternal approach, loculated pericardial effusion
Geliş Tarihi: 06.07.2015 - Kabul Tarihi: 28.09.2015
A 46-year-old female patient with inoperable stage IV small cell lung cancer (SCLC) was admitted to the
emergency department with shortness of breath. On presentation, physical examination revealed a pale
woman who appeared malnourished. The patient’s vital signs were as follows: pulse rate, 115 beats/min;
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respiration rate, 22 breaths/min; body temperature, 37.5 C; and blood pressure, 95/65 mmHg. On physical
examination, breath sounds diminished on the left base and widespread coarse crackles were heard over
the left lung. Other system examination findings were within normal limits. The 12-lead electrocardiogram
showed sinus tachycardia, and lower voltage without marked ST changes. Chest X-ray showed infiltrates on
the left upper zones, and a large left sided pleural effusion (Figure 1A). The transthoracic echocardiograpy
(TTE) revealed large loculated pericardial effusion measuring 3.2 cm in maximal width on the right side of
the heart with cardiac tamponade, and it was comfirmed by multislice computed tomography (Figure 1B).
Due to increased risk of general anesthesia, we preferred echocardiography-guided pericardiocentesis to
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parasternal window . On account of the loculated pericardial effusion adjacent to right atrium and ventricle,
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the right parasternal approach was chosen . Echocardiography-guided pericardiocentesis was performed
under local anesthesia in the operating room owing to increased risk of pneumothorax. The puncture needle
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was advanced through the 6 intercostal space at the right parasternal border, nearly 600 cc of hemorrhagic
fluid was aspirated (Figure 2). After pericardiocentesis, the patient’s vital signs were as follows: pulse rate,
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85 beats/min; respiration rate, 19 breaths/min; body temperature, 37.5 C; and blood pressure, 115/75
mmHg. A very small amount of pericardial effusion was seen with TTE. The fluid cytology was compatible
with metastatic disease. She died from respiratory failure 3 months after the procedure. In conclusion, we
report herein a successful pericardiocentesis via right parasternal approach. Hence this approach can be
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used when a patient has a severe comorbidity .
Conflict of interest: None declared.
Figure Legends
Figure 1A Chest X-ray revealed infiltrates on the left upper zones, and a large left sided pleural effusion. 1B
Multislice computed tomography showed large loculated pericardial effusion on the right side of the heart.
Figure 2 Pericardiocentesis via right parasternal approach
References
1) Mallemat HA, Tewelde SZ. Pericardiocentesis. In: Roberts JR, Hedges JR, editors. Roberts and Hedges’
Clinical Procedures in Emergency Medicine. Philadelphia: Elsevier Saunders; 2014. pp. 312-13.
2) Pandian NG, Brockway B, Simonetti J, Rosenfield K, Bojar RM, Cleveland RJ. Pericardiocentesis under
two-dimensional echocardiographic guidance in loculated pericardial effusion. Ann Thorac Surg. 1988
Jan;45(1):99-100.
3) Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, et al. Consecutive 1127
therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and
outcomes spanning 21 years. Mayo Clin Proc. 2002 May; 77(5):429-36.