Pericardial effusion interventions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2], Hafiz M. Ahmed, M.D.[3]

Overview

Interventions for pericardial effusion primarily refer to pericardiocentesis and image-guided catheter drainage. Pericardiocentesis is recommended when a pericardial effusion causes established or impending cardiac tamponade. It may also be performed for diagnostic purposes when bacterial, tuberculous, or malignant pericardial disease is suspected. Routine pericardiocentesis is not recommended for pericardial effusion without tamponade when there is no specific diagnostic or therapeutic indication.

Indications

• Pericardiocentesis is recommended for established or impending cardiac tamponade, especially in urgent or emergency settings.
• Pericardiocentesis may be performed for diagnostic purposes when bacterial, tuberculous, or malignant pericardial disease is suspected.
• Routine pericardiocentesis is not recommended for pericardial effusion without tamponade when there is no specific diagnostic or therapeutic indication.
• In patients with inflammatory pericardial effusion without concern for tamponade, anti-inflammatory therapy should generally be pursued before pericardiocentesis.

Procedural approach

• Pericardiocentesis may be performed through subxiphoid, apical, or parasternal approaches.
• In emergency settings, a subxiphoid or apical approach is generally preferred.
• In non-emergency settings, the approach should be selected according to the location where pericardial fluid is most accessible and where the risk of injury to surrounding structures is lowest.

Role of imaging guidance

• Echocardiography, fluoroscopy, and/or computed tomography may be used to guide pericardiocentesis.
• Transthoracic echocardiography helps identify the size, location, and hemodynamic effect of the effusion and can help determine a safe access route for drainage.
• Computed tomography-guided pericardiocentesis may be useful in selected challenging cases.