Pericardial Effusion - Tamponade
Pericardial effusion. Measurement should be taken in diastole. Tamponade is a diastolic problem, with restrictive filling. Here, the effusion seems circumferential. Not surprisingly, in a newborns that is lying on his back, the effusion collects posteriorly along the posterior wall of the LV. The fluid can be seen in parasternal short and long axis view in this particular case.
Presence of a small amount of pericardial fluid that almost completely disappears in diastole. The fluid is collected along the right portion around the RV and LV wall. Parasternal short axis view.
Evaluation of restricted filling - PW of RV and LV inflow.
Increased tricuspid valve inflow variability on spectral PW-Doppler (normal <40%)
Increased mitral inflow variability on spectral PW-Doppler (normal <25%)
A good practice is to compress time in order to observe variation in inflow Doppler velocities. This may be altered in individuals that are not spontaneously breathing.
Minimal variation in the mitral valve inflow velocities
Increased variability in the mitral valve inflow velocities
Measurements should be done at the end of diastole. Here, as outlined by the ECG tracing, just before the P-wave.
Emergency Pericardiocentesis Procedure
Multi-Disciplinary Pediatric Point of care Ultrasound Bootcamp Simulation Scenario
The crashing neonate
Case developed by Dr Gabriel Altit and Dr Wadi Mawad
Reviewed by Dr Jade Seguin and Dr Ilana Bank
Updated 01.09.2021 - McGill University - Montreal Children's Hospital
Case shared by Dr Brahim Bensouda from Hôpital Maisonneuve Rosemont
A newborn presented initially with significant retractions without bradycardia. Dr Bensouda, TnECHO specialist and Neonatologist member of the TnECHO Quebec Collaborative, had done the workshop on pericardiocentesis and had trained through simulation on how to perform this technique at the bedside. A TnECHO was obtained and the images are shared below.
The views above are in the subcostal area showing a large pericardial effusion. There is altered filling and contractility. The heart is moving in the pericardial pocket during contraction. The liquid is anechoic (black appearance).
Milky pink fluid aspirated by emergency pericardiocentesis. After puncture, it is important to remove the needle from the catheter to avoid puncture of the muscle wall upon re-expansion while draining the pericardial fluid. The fluid should be sent for cytology / cell count (especially for lymphocytes), culture, total protein, LDH albumin level, triglycerides and biochemistry (electrolytes and glucose) - to evaluate if presence of total parenteral nutrition (TPN) fluid and intravenous lipid fluid. In this case, upon fluid drainage, one can see that the heart function is back to normal with adequate filling. A catheter is seen in the right atrium, which has been withdrawn. The fluid analysis was compatible with extravasated TPN/Lipids.
Presence of pleural effusion on the left posterior side