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DOI:10.2214/AJR.08.1834
AJR 2009; 193:W314-W320
© American Roentgen Ray Society

Original Research

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

Suzanne L. Palmer1, Peter D. Kelly2, Felicia A. Schenkel3 and Mark L. Barr3

1 Department of Radiology, University of Southern California Keck School of Medicine, University Hospital, 1500 San Pablo St., Los Angeles, CA 90033.
2 Department of Radiology, Kaiser Permanente Medical Center, South San Francisco, CA.
3 Department of Surgery, University of Southern California Keck School of Medicine, Healthcare Consultation II, Los Angeles, CA.

OBJECTIVE. 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.

MATERIALS AND 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.

CONCLUSION. 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.

Keywords: cardiac tamponade • CT • pericardiostomy • postoperative pericardial effusion


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