Image in Cardiology
Severely complicated emergency blind pericardiocentesis: Evidence from multimodality imaging
Pericardiocentese cega emergente gravemente complicada: evidência imagiológica multimodal
Manuel Barreiro-Perez
, Ana Martin-Garcia, Marta Alonso-Fernández de Gatta, Pedro L. Sanchez
Corresponding author
Complejo Asistencial Universitario Salamanca (CAUSA), Instituto de Investigación Biomédica Salamanca (IBSAL), CIBER-CV, Salamanca, Spain
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(C) coronary computed tomography angiography showing a short (9 mm), hardly calcified chronic total occlusion lesion: in the middle of the occlusion 100% of the coronary lumen (186 Hounsfield units) was calcified and, in the distal part, 75% of the wall circumference (933 Hounsfield units) was calcified.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo Flores-Umanzor, Victoria Martin-Yuste, Guillem Caldentey, Sara Vazquez, Gustavo Jimenez-Britez, Rodolfo San Antonio, Pedro Cepas-Guillen, Margarida Pujol-Lopez, Marco Hernández, Manel Sabaté" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Flores-Umanzor" ] 1 => array:2 [ "nombre" => "Victoria" "apellidos" => "Martin-Yuste" ] 2 => array:2 [ "nombre" => "Guillem" "apellidos" => "Caldentey" ] 3 => array:2 [ "nombre" => "Sara" "apellidos" => "Vazquez" ] 4 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Jimenez-Britez" ] 5 => array:2 [ "nombre" => "Rodolfo" "apellidos" => "San Antonio" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Cepas-Guillen" ] 7 => array:2 [ "nombre" => "Margarida" "apellidos" => "Pujol-Lopez" ] 8 => array:2 [ "nombre" => "Marco" "apellidos" => "Hernández" ] 9 => array:2 [ "nombre" => "Manel" "apellidos" => "Sabaté" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918303787?idApp=UINPBA00004E" "url" => "/21742049/0000003700000010/v1_201810310641/S2174204918303787/v1_201810310641/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Severely complicated emergency blind pericardiocentesis: Evidence from multimodality imaging" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "867" "paginaFinal" => "868" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Barreiro-Perez, Ana Martin-Garcia, Marta Alonso-Fernández de Gatta, Pedro L. Sanchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Barreiro-Perez" "email" => array:1 [ 0 => "manuelbarreiroperez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Martin-Garcia" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Alonso-Fernández de Gatta" ] 3 => array:2 [ "nombre" => "Pedro L." "apellidos" => "Sanchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Complejo Asistencial Universitario Salamanca (CAUSA), Instituto de Investigación Biomédica Salamanca (IBSAL), CIBER-CV, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pericardiocentese cega emergente gravemente complicada: evidência imagiológica multimodal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 832 "Ancho" => 2500 "Tamanyo" => 169879 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multimodality imaging of the path of the pericardiocentesis catheter crossing the aortic valve to the ascending aorta. (A) Two-dimensional transesophageal echocardiogram, left ventricular outflow tract projection; (B) computed tomography curved format reconstruction along the catheter; (C) three-dimensional volume-rendered computed tomography reconstruction of the catheter insertion point and its relationship with the anterior descending artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 27-year-old woman was admitted to our center after emergency vascular surgery for spontaneous dissection of the left iliac artery. Congenital factor VIII deficiency and family history of complicated brain aneurysm were previously reported. Hemoperitoneum and hemothorax were identified after surgery as consequences of a severe coagulation disorder and the patient suffered cardiac arrest with pulseless electrical activity. A portable echocardiograph detected pericardial effusion and emergency blind subxiphoid pericardiocentesis was performed with recovery of pulse. An urgent cardiology evaluation was subsequently required. Transthoracic echocardiography views were severely limited, so it was decided to undertake transesophageal echocardiography. This revealed a catheter crossing the aortic valve to the ascending aorta (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Contrast-enhanced computed tomography angiography confirmed the intravascular placement of a drainage with its distal tip in the proximal segment of the left carotid artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). The ventricular insertion point was in the anterior interventricular groove, close to the distal segment of the left anterior descending coronary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C). Prior to entering the operating room, the patient suffered a new cardiac arrest and resuscitation maneuvers were ineffective. Subsequent autopsy revealed systemic vascular and tissue fragility (spontaneous liver and spleen lacerations, aortic rupture and hyoid bone fracture with minimal procedural manipulation), compatible with a diagnosis of type 4 Ehlers-Danlos syndrome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This report has two key messages. Pericardiocentesis is not free from severe complications and should be performed with imaging whenever possible. Moreover, a congenital connective tissue disorder should be suspected in young patients with spontaneous arterial complications.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-01" "fechaAceptado" => "2017-09-02" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 832 "Ancho" => 2500 "Tamanyo" => 169879 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multimodality imaging of the path of the pericardiocentesis catheter crossing the aortic valve to the ascending aorta. (A) Two-dimensional transesophageal echocardiogram, left ventricular outflow tract projection; (B) computed tomography curved format reconstruction along the catheter; (C) three-dimensional volume-rendered computed tomography reconstruction of the catheter insertion point and its relationship with the anterior descending artery.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000010/v1_201810310641/S2174204918303507/v1_201810310641/en/main.assets" "Apartado" => array:4 [ "identificador" => "28321" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Image in Cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000010/v1_201810310641/S2174204918303507/v1_201810310641/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918303507?idApp=UINPBA00004E" ]
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