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Selected Reports
Endobronchial Ultrasound
A New Technique of Pericardiocentesis in Posterior Loculated
Pericardial Effusion
Rahul K. Sharma, DM; Arjun Khanna, DM; and Deepak Talwar, DM
Diagnostic and therapeutic pericardiocentesis is traditionally carried out via the transthoracic
route under ultrasound or echocardiographic guidance. Posteriorly located loculated pericardial
effusion cannot be safely drained using the standard subxiphoid or apical, intercostal approach.
In the presence of clinically signicant loculated effusion or effusion requiring diagnostic
pericardiocentesis where an echocardiographic approach is not feasible, patients are usually
referred for surgery. We here present a novel minimally invasive endobronchial ultrasoundguided approach for the aspiration of posteriorly loculated pericardial effusion that may
obviate the need for surgery and its related complications.
KEY WORDS:
journal.publications.chestnet.org
Case Report
A 59-year-old woman, reporting hypertension
and diabetes mellitus for 8 years, presented
to the ED with breathlessness accompanied
by orthopnea and paroxysmal nocturnal
dyspnea for 3 days. She also complained of a
dry cough with fever for the past 15 days and
history of signicant weight and appetite
loss for the past 8 months.
On examination, she was conscious, alert,
febrile, tachypneic, and tachycardic with
BP 100/70 mm Hg and a room air oxygen
saturation of 92%. Her jugular venous
pressure was raised and there were bilateral
e121
Figure 1 CT scan of the chest showing the (A) posteriorly loculated pericardial effusion and the (B) site of endobronchial ultrasound scope placement
in the left lower bronchus for localization of pericardial effusion (arrow).
Figure 2 Endobronchial ultrasound images showing a transbronchial needle aspiration needle in the pericardial space, with the left atrium (LA) below
showing widening of pericardial space during atrial contraction.
Discussion
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Acknowledgments
Financial/nonnancial disclosure: None declared.
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