However, if the bedside ultrasound were to demonstrate a reasonable quantity of drainable ascites (case 2 and a previous report), the avoidance of full laparotomy by either percutaneous catheter placement or a limited subxiphoid
incision would certainly be preferred.
However, in patients with a possible malignant effusion, a subxiphoid pericardial window, which is also a fairly safe procedure, offers the additional benefit of biopsy and has been shown to be more effective in preventing recurrence.
Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.
A bedside pericardiocentesis by subxiphoid
approach under electrocardiographic and echocardiographic guidance was performed, and approximately 700 mL of bloody, nonclotting fluid was drained and sent for culture.
Summary of Sarcomatoid Variant of Anaplastic Large Cell Lymphoma of T-Cell/Null-Cell Lineage Reported in the European and American Literature Age, Initial Source y/Sex Nodal Sites Extranodal Sites Diagnosis Chan 45/M Inguinal, Soft tissue of High-grade et al (4) para-aortic, leg sarcoma and cervical Dusenbery 42/F Inguinal, Breast, Poorly et al (5) paratracheal, subxiphoid
differen- mediastinal, area, right tiated thoracic, groin, psoas malignant para-aortic, muscle, liver, neoplasm right groin pancreas, (carcinoma lymph nodes thyroid, lung, x sarcoma) right thigh Bueso-Ramos 79/M Para-aortic Soft tissues of Malignant et al (6) elbow fibrous histio- cytoma IMH Profile Source Lineage Positive Negative Follow-up Chan et al (4) T cell LCA, CD30, CK CAM5.
These include minimally invasive surgical alternatives (minithoracotomy, video-assisted thoracoscopic surgery, and robotically assisted placement of LV leads), minimally invasive subxiphoid epicardial approach, transseptal endocardial left ventricular lead implantation, and bifocal right ventricular pacing (9, 30-35).
Left heart pacing lead implantation using subxiphoid videopericardioscopy.
This case is unique because of the recurrence of the pericardial effusion even after the pericardial window and drain, Currently, the placement of a pericardial window and subsequent subxiphoid drainage is recognized as a relatively safe and effective treatment of pericardial effusions and cardiac tamponades.
Conclusions: Although a subxiphoid drain is the current recommended treatment for cases involving a pericardial effusion with subsequent tamponade, the risk of recurring effusions even after surgical drainage remains between 0 and 9.
This finding was confirmed during electrophysiological study and by epicardial mapping through a subxiphoid
However, among those who reach the hospital, most cardiac injuries are discovered at admission and treated accordingly, whether initially decompressed with a subxiphoid
pericardial window, or approached with an open thoracotomy.
The patient improved dramatically after an emergent subxiphoid