An unusual procedure for the treatment of simultaneous pericardial and pleural effusions.
BACKGROUND
Symptomatic posterior pericardial effusion (PE) represents a diagnostic challenge since it is not easy to quantify by echocardiography. In addition, this type of effusion is normally treated by surgery because of the difficulty in drainage.


METHODS
A 59-year-old male presented a symptomatic circumferential PE following mitral valve substitution. Two days after a successful percutaneous subcostal pericardiocentesis, he reported severe dyspnea with hypotension and pulsus paradoxus. At chest X-rays, he showed a left pleural effusion; echocardiography, also performed from the left posterior axillary line, showed a large posterior PE and a large pleural effusion separated by a membrane. A needle was inserted at the fourth intercostal space 2 cm medially to the left posterior axillary line and advanced into the pleural and then into the pericardial cavity under echocardiographic guidance. Serous-hemorrhagic fluid was drained from the pericardial (800 cc) cavity and, after retraction, from the left pleural cavities (600 cc), with consequent hemodynamic improvement.


CONCLUSIONS
Pleuro-pericardiocentesis may represent a valid alternative to surgery for the treatment of cardiac tamponade due to posterior pericardial effusions, in the peculiar situation characterized by the simultaneous presence of a left pleural effusion. This procedure should be performed by qualified physicians under echographic guidance.
de Divitiis
M
M
Istituto Medico-Chirurgico di Cardiologia, Seconda Università di Napoli, Ospedale V. Monaldi, Napoli.
Dialetto
G
G
Covino
F E
FE
Caruso
A
A
Cotrufo
M
M
D004322:Drainage; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000601:surgery; D010490:Pericardial Effusion / Q000150:complications / Q000601:surgery / Q000628:therapy*; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011183:Postoperative Complications / Q000601:surgery / Q000628:therapy