title: Computed Tomography-guided Pericardiocentesis: An alternative approach for accessing the pericardium.
abstract: Pericardial effusions compress the heart, decrease cardiac output, and lead to haemodynamic collapse. Ultrasound (US)-guided pericardiocentesis is the gold standard for treating pericardial effusions. Recently, the incorporation of computed tomography (CT) guidance has increased patient safety while entering the pericardium. Despite the superior performance of CT-guided pericardiocentesis in smaller, complex effusions, this procedure is not routinely performed by cardiologists and surgeons. Unlike those with an intact pericardium, patients with mediastinal trauma, pericardial adhesions, temporary pacing wires, and vascular conduits are high risk for pericardiocentesis. Tamponade physiology also increases patient susceptibility to the hypotensive effects of anaesthesia during surgical drainage. Here we illustrate the technique of CT-guided pericardiocentesis and demonstrate its application in specific clinical scenarios. We conclude that CT-guided pericardiocentesis provides a useful, alternative strategy for treating cardiac tamponade in high risk patients.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: John Nicholas
authors.initials: JN
authors.lastname: Melvan
authors.affiliation: Idaho State University, Portneuf Medical Center, Pocatello, ID, USA.
authors.forename: David
authors.initials: D
authors.lastname: Madden
authors.affiliation: Idaho State University, Portneuf Medical Center, Pocatello, ID, USA.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Vasquez
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA; Idaho State University, Portneuf Medical Center, Pocatello, ID, USA. Electronic address: delarosa1@aol.com.
authors.forename: Jacob
authors.initials: J
authors.lastname: DeLaRosa
mesh_terms: D000368:Aged; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010496:Pericardium / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Effusion; Mediastinum; Pericardium; Tamponade