Necip BECİT, Münacettin CEVİZ, Uğur KAYA, Abdurrahim ÇOLAK, Hayri OĞUL

Bilgisayarlı tomografi eşliğinde perikardiyal effüzyon drenajı

Amaç: Bu çalışmada nefrostomi kateteri kullanılarak bilgisayarlı tomografi (BT) eşliğinde yapılan perikardiyal efüzyonların drenajının güvenliliği ve uygulanabilirliği değerlendirildi.Çalışmaplanı:Aralık 2005 - Kasım 2011 tarihleri arasında kliniğimizde 30 hastada (15 erkek, 15 kadın; ort. yaş 52.3 yıl, dağılım 18-80 yıl) BT eşliğinde perikardiyal efüzyon drenajı gerçekleştirildi. Yalnızca ekokardiyografi eşliğinde yapılan drenaj için uygun olmayan hastalar seçildi. Seldinger tekniği kullanılarak 8 veya 10F nefrostomi kateteri perikard boşluğuna ilerletildi.Bul gu lar: İşlem 29 hastada başarılı idi. Bir hastada kateter perikard boşluğuna yerleştirildi; ancak sıvı aspire edilemedi. Bu hasta ameliyata alındı. Perikard boşluğunda organize bir hematoma rastlandı. Ameliyat sırasında sağ ventrikülün anterolateral yüzeyinde küçük bir epikardiyal lazerasyon tespit edildi. On iki hastada (%41) seröz sıvı, 10 hastada (%35) hemorajik sıvı, yedi hastada (%24) transüd ve bir hastada (%3.3) pürülan sıvı aspire edildi. Ortalama 4±2 gün sonra kateterler çıkarıldı. İki hastada (%6.6) perikardiyal efüzyon tekrarladı ve aynı yöntemle başarılı bir şekilde drene edildi. Yeni nüksler gözlenmedi. İşleme bağlı ölüm gerçekleşmedi.So nuç: Çalışma sonuçlarımız ekokardiyografi eşliğinde yapılan drenaj için uygun olmayan hastalarda, nefrostomi kateteri ile BT eşliğinde yapılan drenajın etkili, güvenli ve uygun bir işlem olduğunu göstermektedir. Bununla birlikte, bu tekniğin ameliyat sonrası lokalize perikardiyal efüzyonlu hastalar için daha uygun olduğu görüşündeyiz.

Computed tomography-guided drainage of pericardial effusion

Background: This study aims to evaluate the safety and feasibility of computed tomography (CT)-guided drainage of pericardial effusions by using a nephrostomy catheter. Methods: We performed CT-guided drainage of pericardial effusions on 30 patients (15 males, 15 females; mean age 52±3 years; range 18 to 80 years) in our clinic between December 2005 and November 2011. Only patients who were ineligible for echocardiography-guided drainage were selected. By using the Seldinger technique, a 8 or 10F nephrostomy catheter was inserted into the pericardial space. Results: Procedure was successful in 29 patients. In one patient, the catheter was able to be placed in the pericardial space, but the fluid was unable to be aspirated. The patient was operated. An organized hematoma was found in the pericardial space. During surgery, a small epicardial laceration was detected on the anterolateral surface of the right ventricle. Serous fluid was aspirated from 12 patients (41%), hemorrhagic fluid from 10 patients (35%), transude from seven patients (24%) and purulent fluid was aspirated from one patient (3.3%). Catheters were removed after a mean duration of 4±2 days. In two (6.6%) patients pericardial effusion recurred and successful drainage was performed by the same method. No new recurrences were observed. No procedure-related death was occurred. Conclusion: Our study results suggest that CT-guided drainage with a nephrostomy catheter is an effective, safe and feasible procedure in patients who are ineligible for echocardiography-guided drainage. We also believe that this technique is more suitable for patients with postoperative localized pericardial effusions.

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1. Spodick DH. Diagnostic interpretation of pericardial fluids. Chest 1997;111:1156-7.
2. Oyama J, Shimokawa H, Morita S, Yasui H, Takeshita A. Elevated interleukin-1beta in pericardial fluid of patients with ischemic heart disease. Coron Artery Dis 2001;12:567-71.
3. Strimel WJ, Noe S. Pericardial effusion. eMedicine Journal; 2002. p. 3. Available from: http://www.emedicine.com/med/ topic1786.htm [Retrieved: January 4, 2004]
4. Corda S, Mebazaa A, Gandolfini MP, Fitting C, Marotte F, Peynet J, et al. Trophic effect of human pericardial fluid on adult cardiac myocytes. Differential role of fibroblast growth factor-2 and factors related to ventricular hypertrophy. Circ Res 1997;81:679-87.
5. Berger M, Bobak L, Jelveh M, Goldberg E. Pericardial effusion diagnosed by echocardiography. Clinical and electrocardiographic findings in 171 patients. Chest 1978;74:174-9.
6. Lorell BH. Pericardial disease. In: Braunwald E, editor. Heart Disease a Textbook of Cardiovascular Medicine. 5th ed. Philadelphia: W.B. Saunders; 1997. p. 1478-534.
7. Harken AH, Hammond GL, Edmunds H. Pericardial diseases. In: Edmunds LH JR. Cardiac surgery in the Adult. New York: Mc-Graw Hill; 1997. p. 1303-17.
8. Maisch B, Ristic AD. The classification of pericardial disease in the age of modern medicine. Curr Cardiol Rep 2002;4:13-21.
9. Becit N, Ozyazicioğlu A, Ceviz M, Karakelleoğlu S, Karapolat S, Koçak H. Clinical experience with subxiphoid pericardiostomy in the management of pericardial effusions: a study of 240 cases. J Int Med Res 2003;31:312-7.
10. Bastian A, Meissner A, Lins M, Siegel EG, Möller F, Simon R. Pericardiocentesis: differential aspects of a common procedure. Intensive Care Med 2000;26:572-6.
11. Bruning R, Muehlstaedt M, Becker C, Knez A, Haberl R, Reiser M. Computed tomography-fluoroscopy guided drainage of pericardial effusions: experience in 11 cases. Invest Radiol 2002;37:328-32.
12. Meyer CA, White CS, Wu J, Futterer SF, Templeton PA. Real-time CT fluoroscopy: usefulness in thoracic drainage. AJR Am J Roentgenol 1998;171:1097-101.
13. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999;212:165-8.
14. Bungay HK, Berger J, Traill ZC, Gleeson FV. Pneumothorax post CT-guided lung biopsy: a comparison between detection on chest radiographs and CT. Br J Radiol 1999;72:1160-3.
15. Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 1996;200:851-6.