Pericardiocentesis using echocardiography

Echocardiography is the procedure of choice for the detection and localization of pericardial effusion. It should be performed in all patients prior to elective pericardiocentesis to confirm the diagnosis and to determine the size and location of the effusion in order to minimize the risk and to maximize the yield of pericardiocentesis. When pericardial tamponade is suspected, echocardiography should be performed, time permitting, to document the presence of effusion, because other clinical entities, such as right ventricular failure, may mimic tamponade. Additionally, the finding of diastolic posterior motion of the right ventricular wall, or "diastolic collapse" of the right ventricle, is further evidence for the presence of tamponade and, at times, may eliminate the need for invasive hemodynamic diagnosis. Echocardiography is also useful when performed during pericardiocentesis, to evaluate the size and location of the effusion as the procedure progresses. Contrast echocardiography can determine the position of the pericardiocentesis needle quickly and safely. Thus the appropriate use of echocardiography has increased the safety and improved the yield of diagnostic and therapeutic pericardiocentesis.