Transthoracic ultrasonography is an alternative to subxyphoid ultrasonography for the diagnosis of hemopericardium in penetrating precordial trauma

BACKGROUND: Surgeon-performed ultrasonography is increasingly becoming part of the initial evaluation of patients after blunt or penetrating trauma. C urrently, most institutions obtain a subxyphoid or subcostal view of the he art and pericardial space, and a three-view ultrasonogram of the abdomen to detect blood in the pericardial sac or in three dependent abdominal areas. METHODS: A left parasternal standard transverse transthoracic view is descr ibed in addition to the aforementioned views. This facilitates the visualiz ation of the pericardial sac when a subxyphoid or subcostal view cannot be obtained because of anatomical reasons (narrow subxyphoid space) or local f actors (pain, fractures, subcutaneous emphysema, or chest wall contusion). RESULTS: The transthoracic view can be useful in patients where the subxyph oid view is difficult to obtain through the conventional approach. In most patients an excellent view of the pericardial sac and ventricles can be obt ained and, therefore, expedites the diagnosis and treatment of patients wit h hemopericardium. CONCLUSION: Surgeon-performed ultrasonography has become the diagnostic tes t of choice for patients suspected of having hemopericardium and cardiac ta mponade, Transthoracic ultrasonography is an excellent alternative for thos e patients where a subxyphoid or subcostal view to visualize the pericardia l sac and heart cannot be obtained owing to local or anatomical factors. (C ) 2000 by Excerpta Medica, Inc.