Difficult echocardiogram after pericardiocentesis

Clinical introduction A patient in their 70s, a heavy smoker with low body max index (17 kg/m2) already known for previous relapses of pericarditis on echocardiographic follow-up, was admitted for worsening pericardial effusion (figure 1A,B; ). Given initial signs of cardiac tamponade, the patient underwent urgent pericardiocentesis (subxiphoid approach) with drainage of 1500 cc of pericardial fluid, without evident complications. The pericardial catheter was kept in place for 48 hours until complete resolution of the effusion, and then carefully removed. The next-day echocardiogram was made difficult by the presence in multiple projections of an acoustic shadow and abnormalities in the colour Doppler signal (figure 1C–F; ). Figure 1Panel A: Chest X-ray; panel B: subxiphoic transthoracic echocardiogram obtained prior to pericardiocentesis; panels C and D: post-pericardiocentesis transthoracic echocardiogram diastolic images with and without colour Doppler; panels E and F: post-pericardiocentesis transthoracic echocardiogram...
Source: Heart - Category: Cardiology Authors: Tags: Image challenges Source Type: research