Manuel Oliveira-Santos, Elisabete Jorge, Rui Baptista Luís Leite, Rui Martins, João Calisto, Vítor Matos, Mariano Pego
{"title":"Acute pneumopericardium: when echocardiography is not enough.","authors":"Manuel Oliveira-Santos, Elisabete Jorge, Rui Baptista Luís Leite, Rui Martins, João Calisto, Vítor Matos, Mariano Pego","doi":"10.1080/17482941.2017.1363394","DOIUrl":null,"url":null,"abstract":"A 46-year-old female with metastasized rectal adenocarcinoma complained of progressive exertional dyspnea. The physical exam was remarkable for low blood pressure (98/54 mmHg) and tachycardia (115 bpm). A severe pericardium effusion with right chambers’ collapse was identified, and the patient was submitted to echocardiography-guided pericardiocentesis by a subxiphoid approach, employing a handheld ultrasound device, with fluoroscopy available. The puncture was undertaken uneventfully, with prompt drainage of serous fluid (500 cc) through a 6Fr pigtail catheter paralleled by pericardial effusion reduction on echo. However, it was impossible to obtain an ultrasound window to visualize the heart at the end of the procedure. Diagnosis: Immediate fluoroscopy showed a pneumopericardium (image and video 1), which explained the imaging finding on transthoracic ultrasound. The air was instantly drained with a 50-cc syringe (video 2). The patient remained asymptomatic and the discharge chest radiography was normal. Pneumopericardium is a rare complication of pericardiocentesis, and we hypothesize that it was due to air leakage to the pericardial drainage system (1). Conservative management is reasonable in hemodinamically stable patients (2); however, we proceeded to aspiration as the catheter was in position. Fluoroscopy was crucial for this clinically inapparent diagnosis.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 4","pages":"85"},"PeriodicalIF":0.0000,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2017.1363394","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acute cardiac care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/17482941.2017.1363394","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/2/16 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
A 46-year-old female with metastasized rectal adenocarcinoma complained of progressive exertional dyspnea. The physical exam was remarkable for low blood pressure (98/54 mmHg) and tachycardia (115 bpm). A severe pericardium effusion with right chambers’ collapse was identified, and the patient was submitted to echocardiography-guided pericardiocentesis by a subxiphoid approach, employing a handheld ultrasound device, with fluoroscopy available. The puncture was undertaken uneventfully, with prompt drainage of serous fluid (500 cc) through a 6Fr pigtail catheter paralleled by pericardial effusion reduction on echo. However, it was impossible to obtain an ultrasound window to visualize the heart at the end of the procedure. Diagnosis: Immediate fluoroscopy showed a pneumopericardium (image and video 1), which explained the imaging finding on transthoracic ultrasound. The air was instantly drained with a 50-cc syringe (video 2). The patient remained asymptomatic and the discharge chest radiography was normal. Pneumopericardium is a rare complication of pericardiocentesis, and we hypothesize that it was due to air leakage to the pericardial drainage system (1). Conservative management is reasonable in hemodinamically stable patients (2); however, we proceeded to aspiration as the catheter was in position. Fluoroscopy was crucial for this clinically inapparent diagnosis.