Trans-pleural pericardiocentesis: revisiting an old technique

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Imaging

Background:

• Percutaneous access to the pericardial space is crucial for diagnosing and treating effusions.
• Various techniques exist, including apical, sub-xiphoid, trans-atrial, and trans-bronchial approaches.
• The left axillary approach is an occasional method for combined pleural and pericardial effusions.

Observation:

• This report details the application of the left axillary approach for echocardiographically guided pleuropericardial drainage.
• The technique is particularly relevant when both left pleural effusion and posterior pericardial effusion are present.
• The procedure involves accessing the space between the pericardium and pleura.

Findings:

• The left axillary approach was successfully utilized for pleuropericardial drainage in the presented case.
• This method provides an alternative for managing complex effusions.
• The technique leverages echocardiographic guidance for precision.

Implications:

• Further development, potentially using balloons to expand the pleuropericardial interface, could refine this approach.
• This technique may offer a less invasive alternative to pericardial windows for recurrent effusions.
• Potential applications exist in managing pericardial effusions in oncology and rheumatology.