title: Pericardiocentesis of noncircumferential effusions using nonstandard catheter entry sites guided by echocardiography and fluoroscopy.
abstract: OBJECTIVE
  Classically pericardiocentesis has been described and performed through the subxiphiod approach, which is feasible if the pericardial fluid is circumferential or collected inferior or anterior to the heart. However, not uncommonly, the collection of fluid is at the base of the heart or in the posterior or apical portion of the pericardium, necessitating a different approach. The purpose of this study is to describe echo and fluoroscopic guided pericardiocentesis to evacuate noncircumferential effusions, which are not accessible from the standard subcostal approach.
  
  
  METHODS
  Retrospective review of all patients with localized/noncircumferential effusions at Rady Children's Hospital San Diego between May 2007 and February 2010 was performed. During these procedures, effusions were identified at the point closest to the skin. The pericardial drains were introduced, directed, and advanced under echocardiographic and fluoroscopic guidance while avoiding major organs.
  
  
  RESULTS
  Ten patients were identified (age ranged from 20 days to 22 years, weight ranged from 1.6 kg to 94 kg). All procedures were successful in draining the pericardial effusions with minimal residual fluid and no complications.
  
  
  CONCLUSIONS
  Echocardiographic and fluoroscopic guided pericardiocentesis is a feasible, relatively safe, and reliable technique to drain loculated pericardial effusions using nonstandard entry sites.
authors.affiliation: Rady Children's Hospital-San Diego, Department of Pediatrics, University of California-San Diego, CA 92123, USA.
authors.forename: Delaram
authors.initials: D
authors.lastname: Molkara
authors.forename: Shai
authors.initials: S
authors.lastname: Tejman-Yarden
authors.forename: Howaida
authors.initials: H
authors.lastname: El-Said
authors.forename: John W
authors.initials: JW
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D002140:California; D006328:Cardiac Catheterization; D002648:Child; D004452:Echocardiography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D020519:Pericardiocentesis; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult