Huge Mediastinal Mass with Massive Pericardial Effusion: Role of Echocardiography-Guided Pericardiosintesis

Author : D.P. Kartikasari, D. Soemantri
Upload Date : 19-04-2018

Background: Pericardial effusion with malignancy etiology accounts for 10-25%. Echocardiography remains the primary diagnostic tool for pericardial effusion. The  location  of  pericardial  fluid  is clearly  detected  by  echocardiography which is used as a guidance to determine the puncture site and the direction of puncture needle during pericardiocentesis.

Case: Male, 23 yo, came to ER with dyspnea since last month, there is dypnea on exertion and orthopnea, patient has cough for a month, no fever, bloody cough and weight loss. Patient never smoke, history of TB is denied. No history of trauma nor surgery. Blood pressure is 90/60, with respiratory rate 26 bpm and diminished breath sound on the left basal hemithorax. Chest X-ray shows mediastinum mass and bilateral pleural effusion. Electrocardiography shows sinus tachycardia and low voltage in all leads. Echocardiography in ER shows intrapericardial solid mass 8,8 x 4,5 cm in right lateral,  massive pericardial effusion on right lateral (5.4 cm), anterior (2.3 cm), moderate PE in apical (1.8 cm), basal (1.2 cm), posterior (1.3 cm), inferior (1.1 cm), minimal pericardial effusion on left lateral (0.6 cm) with collapsed right atrial and ventricle. Echocardiography-guided pericardiosintesis is performed in apical approach and 415 cc of serohaemorrhagic pericardial fluid is aspirated.

Discussion: Echocardiographic-guided pericardiocentesis is preferred for its higher success rate (97%) and lower rate of complications (1.2% major complications). Pericardiocentesis may be performed through not only the subxiphoid, but also the apical and rarely, parasternal or lateral regions. The apical approach should be considered when there is anterior pericardial effusion. This approach also reduce the risk of injury to the cardiac chambers compared with subxiphoid approach.

Conclusion: We reported a patient with huge mediastinal mass complicating massive pericardial effusion, echocardiography-guiding pericardiosintesis is performed with apical approach.

KEYWORDS : pericardial effusion, echo guiding pericardiosintesis, mediastinal mass

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