The falciform ligament in the echocardiographic diagnosis of ascites.

OBJECTIVE: The purpose of this study was to show that the falciform ligament (FL) is an important finding on transthoracic echocardiography (TTE) in patients with ascites. BACKGROUND: It is difficult to determine the cause of echo-free spaces around the heart. When an echo-free space is seen anterior to the right ventricle, the identification of the FL helps to distinguish ascites from pericardial effusions, pleural effusions, and pericardial cysts. METHODS: TTE was performed with a 3-MHz multiplane transducer connected to an ultrasound system. Standard TTE and Doppler flow measurements were performed following the American Society of Echocardiography guidelines. A total of 32 patients with ascites were studied. RESULTS: In all 32 patients with ascites noted on clinical examination and documented with abdominal ultrasound, magnetic resonance imaging, computerized tomography, paracentesis, or a combination of these, the FL was identified in the subdiaphragmatic view on TTE examination. CONCLUSION: The FL can be readily visualized on TTE in the subdiaphragmatic view and can aid in the differential diagnoses of translucent space around the right heart border and the liver. The presence of the FL in this echolucent space denotes ascites.

Percutaneous retrieval of a Wallstent from the pulmonary artery following stent migration from the iliac vein.

Wallstents are being used increasingly in conjunction with balloon dilatation for treatment of iliac vein stenosis. Stent misplacement or migration is a complication of the procedure, and may be symptomatic and warrant repositioning or removal. We report the case of a patient whose iliac vein stenosis was managed with two overlapping Wallstents and was complicated by embolization of one stent into the right ventricle (RV) and the other to the pulmonary artery (PA). This article illustrates percutaneous endovascular removal of a migrated stent from the PA using a jugular and femoral approach.