Trans-pleural pericardiocentesis: revisiting an old technique

Percutaneous access to the pericardial space serves both diagnostic and therapeutic purposes. Multiple approaches have been described, which include the apical, sub-xiphoid, trans-atrial, and trans-bronchial techniques. Occasionally, in the presence of both left pleural effusion and posterior pericardial effusion, echocardiographically guided pleuropericardial drainage can be carried out using the left axillary approach. Here we revisit the use of this technique in a patient. Future development of this technique, using a noncompliant balloon to expand the pleuropericardial interface, may avoid the need for a pericardial window in oncology and rheumatology patients with recurrent pericardial effusions.