EURORAD ESR

Case 2585

Percutaneous balloon pericardiotomy

Author(s)
Marcy PY, Bondiau PY, Benezery K, Peyrade F
 
Patient
male, 16 year(s)
 
 
  • Figure 1
    Percutaneous pericardiocentesis

    A 6-French pigtail catheter is advanced over the 0.038 inch guide wire and is left for subsequent drainage of the pericardial cavity. Note the previous intrapericardial injection of a contrast medium via the 22G needle.

     
    Area of Interest: unknown; Imaging Technique: Percutaneous pericardiocentesis;
     
     
  • Figure 2
    Percutaneous balloon pericardiotomy--- First step: balloon positioning

    An 18 x 40 mm high pressure balloon is gently advanced over a 0.0038 inch guide wire into the pericardial cavity under fluoroscopy guidance and cardiac monitoring. The guide wire tip is located in the most posterior...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous ballloon pericardiotomy- First step: balloon positioning;
     
     
  • Figure 3
    Percutaneous balloon pericardiotomy--- Second step: balloon inflation
     

    Figs. 3a, b. Anteroposterior (a) and lateral (b) chest radiograms showing the partially inflated 18x40mm balloon. Manual inflation of the percutaneous epigastric balloon. The balloon waist corresponds to the parietal...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous balloon pericardiotomy- Second step: balloon inflation;

    Figs. 3a, b. Anteroposterior (a) and lateral (b) chest radiograms showing the partially inflated 18x40mm balloon. Manual inflation of the percutaneous epigastric balloon. The balloon waist corresponds to the parietal...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous balloon pericardiotomy- Second step: balloon inflation;

    Fig. 3c. An anteroposterior chest radiogram showing the fully inflated balloon across the parietal pericardium. The balloon stricture disappeared. Thus, pericardiotomy was performed.

     
    Area of Interest: unknown; Imaging Technique: Percutaneous balloon pericardiotomy- Second step: balloon inflation;
     
     
  • Figure 4
    Percutaneous pericardiotomy pathway (CT)
     

    Figs. 4a,b. Axial craniocaudal CT scans of the percutaneous pericardiotomy pathway. Contiguous scans above (4a) and below (4b) the level of the xiphoid process showing the pencil -line thin pericardium (after...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous pericardiotomy pathway (CT);

    Figs. 4a,b. Axial craniocaudal CT scans of the percutaneous pericardiotomy pathway. Contiguous scans above (4a) and below (4b) the level of the xiphoid process showing the pencil -line thin pericardium (after...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous pericardiotomy pathway (CT);
     
     
A 6-French pigtail catheter is advanced over the 0.038 inch guide wire and is left for subsequent drainage of the pericardial cavity. Note the previous intrapericardial injection of a contrast medium via the 22G needle.
 
An 18 x 40 mm high pressure balloon is gently advanced over a 0.0038 inch guide wire into the pericardial cavity under fluoroscopy guidance and cardiac monitoring. The guide wire tip is located in the most posterior recess of the pericardial sac.
 
Figs. 3a, b. Anteroposterior (a) and lateral (b) chest radiograms showing the partially inflated 18x40mm balloon. Manual inflation of the percutaneous epigastric balloon. The balloon waist corresponds to the parietal pericardium, ligaments and phrenic peritoneum.
 
Figs. 3a, b. Anteroposterior (a) and lateral (b) chest radiograms showing the partially inflated 18x40mm balloon. Manual inflation of the percutaneous epigastric balloon. The balloon waist corresponds to the parietal pericardium, ligaments and phrenic peritoneum.
 
Fig. 3c. An anteroposterior chest radiogram showing the fully inflated balloon across the parietal pericardium. The balloon stricture disappeared. Thus, pericardiotomy was performed.
 
Figs. 4a,b. Axial craniocaudal CT scans of the percutaneous pericardiotomy pathway. Contiguous scans above (4a) and below (4b) the level of the xiphoid process showing the pencil -line thin pericardium (after completion of drainage), the catheter crossing through the parietal pericardium, the inferior sternopericardial and phrenicopericardial ligaments, the epicardial fat, the anterior insertions of the diaphragm muscle, the phrenic and parietal peritoneum, and finally the abdominal wall in the subxiphoid area. Liver metastases are shown. Note the entry point at the skin, one centimeter below the xyphoid process.
 
Figs. 4a,b. Axial craniocaudal CT scans of the percutaneous pericardiotomy pathway. Contiguous scans above (4a) and below (4b) the level of the xiphoid process showing the pencil -line thin pericardium (after completion of the drainage), the catheter crossing through the parietal pericardium, the inferior sternopericardial and phrenicopericardial ligaments, the epicardial fat, the anterior insertions of the diaphragm muscle, the phrenic and parietal peritoneum, and finally the abdominal wall in the subxiphoid area. Liver metastases are shown. Note the entry point at the skin, one centimeter below the xyphoid process.
 
 
 
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