PERICARDIOCENTESIS GUIDED BY CONTRAST ECHOCARDIOGRAPHY

Although pericardiocentesis is a relatively safe procedure, there are some hazards, particularly when hemorrhagic fluid is aspirated. Having the opportunity to outline the space from which the fluid is withdraw n is of particular interest in this situation. A current technique of echocardiography with contrast enhancement involves injection of a few milliliters of agitated saline solution or reinjection of blood-stain ed fluid. Performing this procedure, we repeatedly observed a weak and inhomogeneous echo contrast; therefore, rue evaluated the applicabili ty of the ultrasound contrast medium SH U 454 (Echovist Schering, Berl in, Germany) for contrast enhancement in hemorrhagic pericardiocentesi s. In all patients, pericardiocentesis was performed in a supine posit ion, by a subxiphoid approach. A Teflon, catheter/needle unit attached to a syringe containing a few milliliters of contrast medium was intr oduced in, the usual way. On the return of hemorrhagic fluid 1-2 mi of Echovist was injected to provide contrast from the space from which i t had been. aspirated. We observed excellent contrast clearly outlinin g the pericardial space through the injection of 1-2 mi of contrast me dium. No adverse or side effects were seen. resulting from Echovist in jection to the pericardial sac. In conclusion, contrast echocardiograp hy appears to be a useful tool to secure the correct position of the n eedle during pericardiocentesis of hemorrhagic or loculated effusions. It is suggested that injection of Echovist should be considered whene ver the contrast obtained by the conventional technique is poor and in conclusive.