What is the role of CT-guided pericardiostomy in the treatment of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Patients with effusions after cardiothoracic surgery often have limited echocardiographic windows, as well as loculated effusions, and may be on continued ventilatory support, all of which increase the difficulty of echo-guided pericardiocentesis.

CT pericardial fluid drainage has evolved as an emerging technique suited to overcome this dilemma. It has been shown as an alternative technique in patients in whom fluoroscopically or echocardiographically guided pericardiocentesis is difficult. Echocardiography can be limited due to various patient characteristics (eg, postoperative state, obesity, or chronic obstructive pulmonary disease) or due to a limitation of echocardiography in differentiating pericardial fluid from other possible surrounding structures.

In one large series, CT-directed diagnostic and therapeutic pericardiocentesis was attempted in 261 patients, with 98.4% success, 0.3% major complications and 6.9% minor complications. [34]

In 2010, Eichler et al reported their data on CT-guided pericardiocentesis in 20 patients who were poor candidates for echocardiographic drainage or pericardial fluid was not well visualized by echocardiography. All patients had successful drainage, with 0% mortality and no major complications. [35]

A report by Palmer et al suggested that, in postsurgical cases, CT-guided pericardial drainage is both safe and cost effective. The authors reported on 36 patients—33 of whom underwent major cardiothoracic surgery and 3 of whom were treated with minimally invasive procedures—whose symptomatic pericardial effusions were drained using CT-guided percutaneous placement of an indwelling pericardial catheter. [36]

There were no clinically significant complications associated with any of the placement procedures. Thirty-three patients experienced no symptom recurrence following catheter removal, although pericardial effusion did recur in the remaining 3 patients, requiring a repeat treatment.

Comparing procedure costs, the authors determined that the CT-guided tube pericardiostomies cost 89% less than intraoperative pericardial window procedures would have. No significant procedure-cost differences were found between CT-guided and ultrasonographically guided tube pericardiostomies.


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