A Case of Lung Cancer: Malignant Pericardial Effusion Which Was Drained by Subcutaneously Placed Port System

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat to puncture, especially in the case of little effusion space. Here we report a case of non-small cell lung cancer, 71 years old male, who was diagnosed in 2012 and had malignant pericardial effusion as a post-operative recurrence in June 2018. After several chemotherapy regimens, he suffered from dyspnea on effort due to increasing pericardial effusion. We performed pericardial drainage, but 2 months later pericardial effusion had increased again. The need of repeating of pericardial drainage was estimated, so we placed subcutaneously placed port system into his pericardial space. Thereafter, we drained pericardial effusion through it on demand for his dyspnea. Gradually his circulatory status had been exacerbated and he died on 36th day after the procedure. In the case of malignant pericardial effusion, the subcutaneously placed port system may be useful because repeated aspiration can be done by single procedure of pericardial puncture. It may keep quality of life of patients and more cases should be experienced and assessed.

Penetrating Aortic Root Injury / 日本心臓血管外科学会雑誌

The patient was a 25-year-old man, who had been stabbed with a weapon siarilar to long ice pick. Thirty minutes later, he was admitted to our emergency center by ambulance. Anchocardiogram on admission revealed moderate pericardial effusion with normal heart function. Contrast medium enhanced computed tomography revealed that the weapon had entered from the left anterolateral chest wall and reached the posterior wall of the aortic root, approximately 1 cm above the left coronary artery orifice, through the left lung. During examinations, he suddenly went into shock and emergency open pericardial drainage was performed immediately. Approximately 400 ml of blood with a clot was removed from the pericardial cavity. After this procedure, there was no continuous bleeding. Subsequently, pseudoaneurysm developed at the aortic root injury site. Twenty seven days later, aortic surgery was performed. The injury site was resected and sutured directly, employing 4-0 polypropylene sutures with felt pledgets. He was discharged 14 days after the operation without any complications.

Symptom resolution by pericardial drainage in a terminal cancer patient with pericardial abscess following pericardial emphysema

A 42-year-old man with primary tongue cancer was admitted to our palliative care center for the control of pain due to multiple bone metastases. On 30th day after admission, he was suffering from pneumonia. And on 37th day, chest radiograph demonstrated pericardial emphysema, which developed to the pericardial abscess. Chest Computed Tomography showed lymph nodes metastases around the left main bronchus, and revealed that there was a fistula between the left main bronchus and the pericardium. The patient was faced to the difficulty in taking spine position because of excessive excretion of the sputum. Pericardiocentesis was then performed percutaneously and a tube for the drainage was placed. After the placement of drain tube, he restored good night sleep in the spine position and the complaints were reduced. Palliat Care Res 2008; 3(2): 321-325

The new choice of pericardiocentesis route for percutaneous indwelling catheter drainage in patients with pericardial effusion / 中国介入心脏病学杂志

Objective To investigate the efficacy and safety of percutaneous pericardial drainage with indwelling catheter via the puncturing route of left sternal broader in the third or fourth interspace Methods In the 38 patients with moderate to large pericardial effusion, the pericardial echo free space and the forecasted puncturing distance were measured with two dimensinal echocardiolgraphy (2DE) prior to pericardiocentesis in the three sites: subxiphoid, cardiac apex and the left sternal broader in the third or fourth interspace Under the guidance of 2DE, pigtail catheters were percutaneously indwelled for pericardial drainage via the location of left sternal broader in the third or fourth interspace Results Among the three sites, there were no difference of echo free space measured by 2DE, and the forecasted distance of advancing needle examined in left sternal broader was the smallest The procedures of indwelling catheter drainage for pericardial effusion were successfully performed in all the 38 patients Catheters lying in posterior pericardium were found in 94 8% of the patients (36/38) There were no cases with puncturing related complications, effusion leaking into pleurum or subcutaneous tissue Only 1 case was complicated with neural mediated syncope on the third day after indwelling catheter Conclusion Pericardiocentesis using left sternal broader route is a safe and simple approach for indwelling catheter drainage in patients with pericardial effusion This route may be a promising option for clinical use widely