The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

Abstract

Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

Pericardial effusion in idiopathic inflammatory myopathies: A cross-sectional study from Asia and review of the literature

“…Due to the small sample size, some clinical features may have been over-amplified, so we also included a review of published cases in the literature to overcome these problems. Studies have suggested that the frequency of IIMs with pericardial effusion is 12.37%–17%, 23 which is similar to the 12.2% in this study, and similar to other studies, the patients with pericardial effusion in our collected cases are all small or moderate pericardial effusions (small effusion is 50–100 mL, moderate effusion is 100–500 mL, and large effusion> 500 mL); however, if there is no large amount of pericardial effusion or pericardial tamponade, 7 , 24 – 27 it is more reliable.…”

EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION

“…The final research question and search strategy, PRISMA flow diagram, and summary table of the final included studies are shown in tables Q1.1, Q1.2, and Q1.3, respectively. 21 references were represented 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 . The final summary of evidence, assignment of levels of evidence, and GRADE recommendation for this question are shown in table Q1.4.…”

Cardiac Tamponade: A Case for Point-of-Care Ultrasound

“… 6 Pericardiocentesis guided by echocardiography can be successfully performed over 95% of the time and may reduce both the “door to pericardiocentesis time” and hospital length of stay. 8 , 9 , 10 Despite various success rates, the “blind” approach remains common, especially in emergency situations. Computed tomography models estimate the success rate of the blind approach can be as high as 87% using the subxiphoid approach but much lower (∼60%) using the apical approach.…”