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Image challenge
Difficult echocardiogram after pericardiocentesis
  1. Massimo Mapelli1,2,
  2. Francesco Balata1,2,
  3. Claudia Lucci1
  1. 1 Centro Cardiologico Monzino IRCCS, Milan, Italy
  2. 2 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  1. Correspondence to Dr Massimo Mapelli, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy; massimo.mapelli{at}ccfm.it

https://doi.org/10.1136/heartjnl-2023-323338

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    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; online supplemental video 1). 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; online supplemental videos 2 and 3).

    Supplementary video

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    Supplementary video

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    Supplementary video

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    Figure 1

    Panel 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 systolic frames with and without colour Doppler. LV, …

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    Footnotes

    • Twitter @MapelliMassimo

    • Collaborators None.

    • Contributors MM, FB and CL have all contributed substantially to this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.