超声引导下心包穿刺置管引流术治疗心包积液的疗效分析

 目的 探讨超声引导下心包穿刺置管引流急慢性心包积液的疗效。方法 回顾分析2009-01至2019-08医院161例行超声引导下心包穿刺置管引流术患者的临床资料,并对其病因、症状、缓解情况进行分析。结果 161例心包积液患者前三位的病因分别为肿瘤、心力衰竭、创伤或手术,经超声引导下心包穿刺置管术治疗后症状缓解率均在70%以上。结论 超声引导下心包穿刺置管引流术治疗心包积液疗效确切,可作为临床治疗心包积液特别是急性心包压塞的首选治疗方式。     

经皮球囊二尖瓣成形术心脏穿孔与心脏压塞的处理

目的　阐明经皮球囊二尖瓣成形术 (PBMV)心脏穿孔与心脏压塞的诊断与处理方法。方法与结果　自 1992年 5月～ 2 0 0 1年 12月 ,对 772例风湿性心脏病二尖瓣狭窄患者 (年龄 14岁～ 74岁 )进行了经皮球囊二尖瓣成形术。 9例发生了心脏穿孔 ,其中 2例发生心脏压塞 ,经剑突下途径进行造影剂和X线指示下心包穿刺引流术后完全缓解 ,未行外科处理。结论　PBMV时房间隔穿刺针和Mullins鞘管导致的心脏穿孔仅少数可导致心脏压塞 ;有心脏压塞临床症状和X线透视下心影搏动消失可诊断心脏压塞 ;X线透视和造影剂指示下心包穿刺引流术是一种最快速有效的缓解症状的方法 ,多可避免开胸手术。     

Pericardial effusion and pericardial compartments after open heart surgery. An analysis by computed tomography and echocardiography

Thirty-three patients with pericardial effusion after open heart surgery were investigated with computed tomography (CT). Twelve of the 33 patients also underwent echocardiography prior to pericardiocentesis. The effusions were typed according to the results of the CT investigation. Because of postoperative adhesions, typical patterns of localized pericardial effusions were found in 16 patients. The localized compartments were seen on the right and left side of the heart and around the aorta and the pulmonary artery. CT was therefore shown to be of value for selecting the approach for drainage with catheter pericardiocentesis.     

Detection of impending pericardial tamponade during skeletal imaging

Bone imaging using Tc-99m MDP was performed on a 68-year-old man with a newly diagnosed adenocarcinoma of the lung. The image unexpectedly showed increased activity in the heart area. Emergent echocardiography demonstrated impending pericardial tamponade. A malignant pericardial effusion was verified by pericardiocentesis.     

心包造影(附20例报告)

目的：探讨心包积液病人心包造影的方法及临床价值。方法：对２０例不同病因的心包积液病人经剑突下心包穿刺,心包腔内放置引流管并行泛影葡胺及空气造影。结果：心包造影后显示心脏被积液包裹,有心脏填塞症状者,可见到心脏受压,且以心房为著;心包充气后,心包轮廓清晰;结核性、化脓性和癌性心包病变者,心包壁层增厚、僵硬、可有钙化,其他病因的心包壁层光滑、薄、无僵硬感;心包积液吸收后造影,可观察有无心包粘连。结论：心包造影有助于研究心脏受压程度,指导抽液和判断积液剩余量,有助于观察心包厚度、钙化和局部粘连情况。     

Complications of percutaneous pericardiocentesis under fluoroscopic guidance.

Complications in 352 cases of fluoroscopy-guided percutaneous pericardiocentesis accomplished through an indwelling catheter were reviewed following surgery and non-surgery. Thirteen major complications were found, namely 3 cardiac perforations, 2 cardiac arrhythmias, 4 cases of arterial bleeding, 2 cases of pneumothorax in children, one infection, and one major vagal reaction. No significant difference in complications was found between pericardiocenteses for pericardial effusions after cardiac surgery (n = 208) and those for effusions of non-surgical (n = 144) origin. Fluoroscopy-guided pericardiocentesis by the subxiphoid approach with placement of an indwelling catheter is a safe method for achieving pericardial drainage in both surgical and non-surgical effusions. Accidental cardiac perforation with a fine needle is a minor complication as long as the needle is directed towards the anterior diaphragmatic border of the right ventricle and drainage is achieved with a reliable indwelling catheter.     

Intrapericardial installation of radioactive chromic phosphate in malignant effusion.

Treatment of 28 patients with malignant pericardial effusion was accomplished primarily by intrapericardial instillation of radioactive chromic phosphate. At time of diagnosis of pericardial disease, 14 patients had major manifestations of tamponade; the rest had little or no clinical evidence of effusion. Only eight of the 28 patients had further problems with effusion after the initial pericardiocentesis and 32P instillation. Additional aspirations were done on those patients 2 weeks to 5 months later. The average survival was 9 months; seven patients lived more than 1 year.     

Unsuccessful pericardiocentesis for cardiac tamponade during angiocardiography with nonionic contrast material

Cardiac tamponade secondary to ventricular wall perforation is one of the possible complications of right-sided as well as left-sided cardiac catheterization. Ventriculography was performed on a patient with obstructive cardiomyopathy using a nonionic contrast medium. During the procedure, the right ventricle was accidentally perforated and the patient developed cardiac tamponade. Pericardiocentesis was unsuccessful and surgical drainage was needed after the patient developed progressive hemodynamic deterioration. At surgery, pericardial thrombus was found. We consider the reason for failure of pericardiocentesis was rapid coagulation of the extravasated blood in connection with nonionic contrast material.     

Percutaneous catheter drainage for malignant pericardial effusion.

Ultrasound (US)-guided and fluoroscopically guided pericardial catheter placement was performed in 12 patients with known underlying malignancy who had clinical and radiographic evidence of a significant pericardial effusion. US guidance facilitated placement of a 22-gauge needle by means of a subxyphoid or transthoracic approach. The tract was subsequently dilated over a wire under fluoroscopic guidance with placement of either an 8.5- or 10-F catheter. This technique successfully established pericardial drainage in all patients with excellent symptomatic relief. Cytologic findings were positive for malignancy in 10 of the 12 patients. Radiologically guided pericardiocentesis allowed safe, rapid stabilization of the condition of patients with symptoms from pericardial effusion. This resulted in excellent palliation in patients with terminal disease and improvement in the clinical status of other patients so that additional therapies, such as sclerosis with tetracycline or surgical placement of a pericardial window, could be performed on an elective basis.     

Percutaneous pericardiotomy with balloon catheter in the treatment of malignant pericardial effusion in dogs

INTRODUCTION: Cardiac tamponade is an emergency clinical condition both in man and the dog. Neoplastic pericardial effusion caused by primary or metastatic tumors is one of the most frequent causes in the dog. The frequent relapses after pericardiocentesis have led to developing different procedures for pericardial removal or fenestration to improve the quality of life in both terminal and treated patients. The often critical condition of these patients calls for procedures causing as little surgical stress as possibile, which is the case of percutaneous pericardial balloon dilatation. We report our experience with this procedure in the first two dogs whose long-term follow-up is available. MATERIAL AND METHODS: Dogs need a short general anesthesia for restraining problems, while in man a slight sedation is sufficient. The anatomy being different, the percutaneous approach is intercostal in the dog and transdiaphragmatic in man. Echocardiographic guidance and fluoroscopic control are necessary during the procedure in both species. We report the clinical history of two dogs with neoplastic pericardial effusion, primary in one case and metastatic in the other. Both dogs were treated with pericardial balloon dilation. DISCUSSION AND CONCLUSIONS: Our experience in the dog and in man shows that percutaneous pericardial balloon dilation causes less patient stress than thoracotomic or thoracoscopic pericardiectomy. Moreover, the surgical cost is lower and hospitalization time is reduced. On the other hand, the surgical methods permit bioptic sampling and better and more thorough studies of chest structures. We suggest percutaneous pericardiectomy as a valid alternative to surgery to treat chronic benign pericarditis, which obviously needs further confirmation from dedicated studies.     

Purulent pericarditis in advanced thymoma: A case report

Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial effusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non-productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericarditis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient''s condition deteriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymic pathologies should be included as a rare etiology in the differential diagnosis of purulent pericardial effusion.     

Ultrasonic detection of pericardial effusions adjacent to the right atrium during routine examination of the upper abdomen.

Pericardial effusions are usually detected on ultrasound by examining the heart with time--motion (T/M) or real-time equipment through a left chest intercostal space. Since fluid within the pericardium also accumulated around the right atrium, effusions can also be diagnosed by observing fluid separating the right atrium from hemidiaphragm on parasagittal scans of the right upper abdomen. In order to be certain that this space represents pericardial rather than pleural fluid, the inferior vena cava must be identified along the lower margin of the fluid space as a tubular structure traversing from the diaphragm into the right atrium. Our procedure is proposed as an ancillary approach for detecting clinica-ly unsuspected effusions during the routine examination of the upper abdomen rather than as a replacement for the usual method of visualising pericardial effusions.     

Real-time ultrasound diagnosis of deep vein thrombosis: a comparison with venography

A prospective study comparing real-time ultrasound scanning with contrast venography in the diagnosis of deep venous thrombosis of the lower limb was performed in a group of 46 patients. The sensitivity of ultrasound scanning for thrombus within the iliofemoral segment, femoral vein, and popliteal vein was 94% with a specificity of 100%. Additional information obtained by ultrasound included the diagnosis of popliteal cysts, pelvic and inguinal lymphadenopathy, popliteal haematoma, and traumatic arterial aneurysm. Real-time ultrasound scanning is a rapid and non-invasive alternative to contrast venography in the diagnosis of lower limb deep venous thrombosis.     

CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

Objective

To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children.

Methods

20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative.The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion.

Results

All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication.

Conclusions

Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.     

Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound

The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver ultrasound. Over the past few years several reports have shown that contrast ultrasound can substantially improve detection and characterization of focal liver lesions with respect to baseline studies. The advent of second-generation agents and low mechanical index real-time scanning techniques has been instrumental in improving the easiness and the reproducibility of the examination. With the publication of the guidelines for the use of contrast agents in liver ultrasound by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast ultrasound enters into clinical practice. The guidelines define the indications and recommendations for the use of contrast ultrasound in focal liver lesion detection, characterization, and follow-up after tumor ablation procedures. We discuss the impact of EFSUMB guidelines on diagnostic protocols currently adopted in liver imaging.     

Sonographic recognition of multiple cystic encephalomalacia

Multiple cysts in both hemispheres were detected in four children under 1 year of age by real-time sonographic sector scanning. These cysts, typical of multiple cystic encephalomalacia, followed viral encephalitis in two, bacterial meningitis in one, and bacterial meningitis superimposed on intracerebral hemorrhage in one. The diagnosis of multiple cystic encephalomalacia, which has a grave prognosis, is readily made with high-resolution real-time sonography.     

The missing balloon sign

The balloon of the self-retaining Foley catheter should be readily visible during ultrasound scanning of the distended urinary bladder. Its absence should prompt a search for its location since extra-vesical inflation may result in local trauma and confusing appearances.     

Work in progress: intraoperative ultrasonography of the spine

We demonstrate the application of intraoperative real-time ultrasound sector scanning in two patients who had spinal tumors. The scans were obtained through a 4- to 5-cm deep, saline-filled operative field. Ultrasonography imaged the tumors, the relationships of the lesions to the spinal cords, and the normal internal structures of the cords themselves. The technique could prove useful in certain forms of spinal surgery.     

The cushion scanning technique: A method of dynamic tongue sonography and its comparison with the transducer-skin coupling scanning technique during swallowing

Rationale and Objectives

We describe the cushion scanning technique (CST), which solves common difficulties encountered during ultrasound investigations of swallowing. These problems arise when the transducer is held in direct contact with the submental area. Some of these problems include movements of the ultrasound transducer during swallowing and compression of the submental region, which causes abnormal swallowing patterns.

Methods

To compare ultrasound images produced with the conventional hand-held transducer-skin coupling scanning technique with the CST, we studied five participants with no clinical signs of tongue dysfunction. All tongue movements were recorded by real-time B+M-mode sonography.

Results

Images produced with the hand-held transducer were found to be unstable because the transducer moved during swallowing, thereby changing the scanning section. By contrast, the transducer and the participant's head remained in a constant position throughout the CST trial. There was no obvious compression of the submental muscles.

Conclusion

The CST allows for a better intraindividual reproducibility of the swallowing pattern and for a more standardized and objective ultrasound examination than the hand-held transducer-skin coupling scanning technique.     

The use of real-time orbital ultrasound in Graves' ophthalmopathy: a comparison with computed tomography

Evaluation of the severity of orbital involvement and likelihood of the development of optic neuropathy in Graves' disease can be clinically difficult. We describe the use of real-time orbital ultrasound scanning to measure the medial rectus muscle width in 20 patients with Graves' ophthalmopathy and 21 normal individuals. The normal reference interval (to 2 SDs) was 1.75 to 4.07 mm. Significantly (p less than 0.001; Mann Whitney U-test) larger values were observed in the patients compared with controls, and there was good correlation between medial rectus width and a clinical index of disease severity in individual eyes (p less than 0.001; Spearman rank correlation coefficient). Comparison of the medial rectus measurements obtained using orbital computed tomography and ultrasound showed positive correlation at the p less than 0.001 significance level. Computed tomographic medial rectus measurements also correlated with horizontal and vertical muscle indices for that orbit. We suggest that real-time ultrasound of medial rectus width, using widely available equipment, provides an accurate, simple and non-invasive means of evaluating the orbits of patients with Graves' disease. Repeated measurements may be of value in identifying patients at high risk of visual failure, and in following prospectively the orbital response to therapy in patients with Graves' ophthalmopathy.