CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion.
OBJECTIVE
The purpose of this study was to analyze the efficacy and examine the competitive cost of CT-guided tube pericardiostomy in the management of symptomatic postsurgical pericardial effusion.


METHODS
Over a 4-year period, 36 patients with symptomatic pericardial effusion were treated with CT-guided percutaneous placement of an indwelling pericardial catheter, for a total of 39 CT-guided tube pericardiostomy procedures. Thirty-three patients (92%) had undergone major cardiothoracic surgery, and three patients (8%) had undergone minimally invasive procedures. The medical records were retrospectively reviewed for clinical presentation, surgical history, imaging studies performed, procedural details, fluid characterization, and outcome. Charge comparison was performed with the American Medical Association Current Procedural Terminology codes and information acquired from the billing department at our facility.


RESULTS
All 39 CT-guided tube pericardiostomy procedures were performed successfully without clinically significant complications. After 33 of the 39 procedures (85%), symptoms did not recur after the catheter was removed. Three of 36 patients (8%) had a recurrence of pericardial effusion. Comparison of procedure charges showed an 89% saving over intraoperative pericardial window procedures and no significant difference compared with ultrasound-guided tube pericardiostomy. Eight patients (21% of procedures) needed pleural drainage procedures, all of which were performed in the CT suite immediately after the tube pericardiostomy procedure.


CONCLUSIONS
CT-guided tube pericardiostomy is a safe and effective alternative to surgical drainage in the care of patients with clinically significant pericardial effusion after cardiothoracic surgery and has the additional benefit of substantial cost savings.
Palmer
Suzanne L
SL
Department of Radiology, University of Southern California Keck School of Medicine, University Hospital, Los Angeles, CA 90033, USA. spalmer@usc.edu
Kelly
Peter D
PD
Schenkel
Felicia A
FA
Barr
Mark L
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D010492:Pericardiectomy / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome