CT-Guided Tube Pericardiostomy: A Safe and Effective Technique in the Management of Postsurgical Pericardial Effusion

AJR Am J Roentgenol. 2009; 193(4):314-320

Palmer SL, Kelly PD, Schenkel FA, Barr ML

OBJECTIVES: The purpose of this study was to analyze the efficacy and examine the competitive cost of CT-guided tube pericardiostomy in the management of symptomatic postsurgical pericardial effusion.

METHODS: Over a 4-year period, 36 patients with symptomatic pericardial effusion were treated with CT-guided percutaneous placement of an indwelling pericardial catheter, for a total of 39 CT-guided tube pericardiostomy procedures. Thirty-three patients (92%) had undergone major cardiothoracic surgery, and three patients (8%) had undergone minimally invasive procedures. The medical records were retrospectively reviewed for clinical presentation, surgical history, imaging studies performed, procedural details, fluid characterization, and outcome. Charge comparison was performed with the American Medical Association Current Procedural Terminology codes and information acquired from the billing department at our facility.

RESULTS: All 39 CT-guided tube pericardiostomy procedures were performed successfully without clinically significant complications. After 33 of the 39 procedures (85%), symptoms did not recur after the catheter was removed. Three of 36 patients (8%) had a recurrence of pericardial effusion. Comparison of procedure charges showed an 89% saving over intraoperative pericardial window procedures and no significant difference compared with ultrasound-guided tube pericardiostomy. Eight patients (21% of procedures) needed pleural drainage procedures, all of which were performed in the CT suite immediately after the tube pericardiostomy procedure.

CONCLUSIONS: CT-guided tube pericardiostomy is a safe and effective alternative to surgical drainage in the care of patients with clinically significant pericardial effusion after cardiothoracic surgery and has the additional benefit of substantial cost savings.

PMID: 19770301

2 Responses

  1. Ronen Rubinshtein, MD  on October 19th, 2009

    Echo-guided pericardiocentesis is a common method to perform the procedure, especially during an emergent situation. However, CT guided drainage may be an interesting alternative, especially in the post operative period; although, the CT suite may not be an optimal location for hemodynamically unstable patients.

  2. Suzanne Palmer, M.D.  on November 3rd, 2009

    It may be true that the CT suite is not optimal for an unstable patient, but we have unstable patients from the ICU on a daily basis for diagnostic studies. The patient will likely be moved out of the ICU for a surgical procedure if the pericardial fluid cannot be drained at the bed-side, so one should think of the CT suite as an operating room. We do many interventional procedures using CT guidance, so we consider the CT room to be an interventional suite. There should be enough room to have monitors (both electronic and human) when necessary, though.


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