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Théry G, Gascon V, Fraile V, Ochagavia A, Hamzaoui O. How to use echocardiography to manage patients with shock? Med Intensiva 2024; 48:220-230. [PMID: 38151372 DOI: 10.1016/j.medine.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 12/29/2023]
Abstract
Echocardiography enables the intensivist to assess the patient with circulatory failure. It allows the clinician to identify rapidly the type and the cause of shock in order to develop an effective management strategy. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied. Early and repeated echocardiography is a valuable tool for the management of shock in the intensive care unit. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. The four core types of shock (cardiogenic, hypovolemic, obstructive, and septic) can readily be identified by echocardiography. Echocardiography can differentiate the different pathologies that may be the cause of each type of shock. More importantly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock, which emphasises on the added value of transthoracic echocardiography (TTE) in such population of patients. In this review we aimed to provide to clinicians a bedside strategy of the use of TTE parameters to manage patients with shock. In the first part of this overview, we detailed the different TTE parameters and how to use them to identify the type of shock. And in the second part, we focused on the use of these parameters to evaluate the effect of treatments, in different types of shock.
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Affiliation(s)
- Guillaume Théry
- Service de Médecine Intensive - Réanimation Polyvalente, Hôpital Robert Debré, Centre Hospitalo-Universitaire de Reims; Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801.
| | - Victor Gascon
- Servicio de Medicina Intensiva, Hospital Universitario de la Ribera, Alcira (Valencia)
| | - Virginia Fraile
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid
| | - Ana Ochagavia
- Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Olfa Hamzaoui
- Service de Médecine Intensive - Réanimation Polyvalente, Hôpital Robert Debré, Centre Hospitalo-Universitaire de Reims; Unité HERVI "Hémostase et Remodelage Vasculaire Post-Ischémie" - EA 3801
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Mohammed NA, Al-Zubairi TA, Al-Soumai MH. A case report on ultrasound-guided pericardiocentesis with a right parasternal approach: a novel in-plane lateral-to-medial technique. Int J Emerg Med 2024; 17:15. [PMID: 38302868 PMCID: PMC10835824 DOI: 10.1186/s12245-024-00592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/26/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Emergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade. CASE PRESENTATION We present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient's condition. TECHNIQUE DESCRIPTION The proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion. CONCLUSION The presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.
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Affiliation(s)
- Najem Abdullah Mohammed
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen.
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen.
- POCUS Academy, Sana'a City, Yemen.
| | - Tanweer A Al-Zubairi
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
| | - Moad H Al-Soumai
- Emergency Department and Intensive Care Unit, Al Zamalh Hospital, Mawia Street, Taiz City, Yemen
- Faculty of Medicine and Health Sciences, Taiz University, Habeel Street, Taiz, Yemen
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Messina Alvarez AA, Bilal MA, Manasrah N, Chaudhary A. Iatrogenic Cardiac Tamponade Secondary to Central Venous Catheter Placement: A Literature Review. Cureus 2023; 15:e37695. [PMID: 37206520 PMCID: PMC10191201 DOI: 10.7759/cureus.37695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Cardiac tamponade is the fluid accumulation within the pericardial sac that compresses the heart and decreases cardiac output. More than 20% of the cases are surgical or non-surgical iatrogenic causes. Cardiac tamponade has been described as a rare complication of central venous catheter placement with an incidence in adults as low as less than 1% but with significantly high mortality of more than 60%. The purpose of this article is to review the incidence, clinical manifestations, pathophysiology, diagnosis, and management of cardiac tamponade after central venous catheter placement as well as different methods to prevent this fatal complication from occurring.
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Affiliation(s)
| | - Mohammad A Bilal
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
| | - Ahmed Chaudhary
- Internal Medicine, Detroit Medical Center (DMC) Sinai-Grace Hospital, Detroit, USA
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Postinfluenza Cardiac Tamponade: A Review of Published Case Reports. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:64. [PMID: 36721865 PMCID: PMC9880915 DOI: 10.1007/s42399-023-01412-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/28/2023]
Abstract
Increased vaccination rates and better understanding of influenza virus infection and clinical presentation have improved the disease's overall prognosis. However, influenza can cause life-threatening complications such as cardiac tamponade, which has only been documented in case reports. We searched PubMed/Medline and SCOPUS and EMBASE through December 2021 and identified 25 case reports on echocardiographically confirmed cardiac tamponade in our review of influenza-associated cardiac tamponade. Demographics, clinical presentation, investigations, management, and outcomes were analyzed using descriptive statistics. Among 25 cases reports [19 adults (47.6 ±15.12) and 6 pediatric (10.1 ± 4.5)], 15 (60%) were females and 10 (40%) were male patients. From flu infection to the occurrence of cardiac tamponade, the average duration was 7±8.5 days. Fever (64%), weakness (40%), dyspnea (24%), cough (32%), and chest pain (32%) were the most prevalent symptoms. Hypertension, diabetes, and renal failure were most commonly encountered comorbidities. Sinus tachycardia (11 cases, 44%) and ST-segment elevation (7 cases, 28%) were the most common ECG findings. Fourteen cases (56%) reported complications, the most common being hypotension (24%), cardiac arrest (16%), and acute kidney injury (8%). Mechanical circulatory/respiratory support was required for 14 cases (56%), the most common being intubation (9 cases, 64%). Outcomes included recovery in 88% and death in 3 cases. With improving vaccination rates, pericardial tamponade remains an infrequently encountered complication following influenza virus infection. The complicated cases appear within the first week of diagnosis, of which nearly half suffer from concurrent complications including cardiac arrest or acute kidney injury. Majority of patients recovered with timely diagnoses and therapeutic interventions.
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Gottlieb M, Alerhand S. Managing Cardiac Arrest Using Ultrasound. Ann Emerg Med 2022; 81:532-542. [PMID: 36334956 DOI: 10.1016/j.annemergmed.2022.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022]
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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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Latif RK, Clifford SP, Ghafghazi S, Phipps Z, Chen JJ, Sangroula D, Khan AZ, Saleem J, Farah I, Huang J, Businger JR. Echocardiography and Management for Cardiac Trauma. J Cardiothorac Vasc Anesth 2022; 36:3265-3277. [DOI: 10.1053/j.jvca.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
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Farouji I, Damati A, Chan KH, Ramahi A, Chenitz K, Slim J, Shamoon F. Cardiac Tamponade Associated with Human Immunodeficiency Virus-Associated Immune Complex Kidney Disease. J Glob Infect Dis 2021; 13:151-153. [PMID: 34703158 PMCID: PMC8491815 DOI: 10.4103/jgid.jgid_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/07/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Cardiac tamponade is a life-threatening emergency, characterized by rapid accumulation of pericardial fluid. There are multiple risk factors for cardiac tamponade, nephrotic syndrome is an uncommon one, especially in adults. Herein, we are reporting a 35-year-old African American woman with membranoproliferative glomerulonephritis secondary to human immunodeficiency virus-associated immune complex kidney disease (HIVICK), who presented with cardiac tamponade. The patient had pericardiocentesis and was discharged, with outpatient follow-up with cardiology, nephrology, and infectious disease. To the best of our knowledge, this is the first report of HIVICK nephrotic syndrome associated with cardiac tamponade.
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Affiliation(s)
- Iyad Farouji
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Ahmad Damati
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Kok Hoe Chan
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Amr Ramahi
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Kara Chenitz
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States.,Department of Nephrology, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Jihad Slim
- Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States.,Department of Infectious Disease, Saint Michael's Medical Centre, New York Medical College, Newark, New Jersey, United States
| | - Fayez Shamoon
- Department of Cardiology, Saint Joseph University Hospital, Newark, New Jersey, United States
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Santos CD, Propst JA, Canabal JM, Goswami RM. Lateral-Apical Approach to Pericardiocentesis for Treatment of Cardiac Tamponade Immediately Post-orthotopic Liver Transplantation. Cureus 2021; 13:e15684. [PMID: 34277273 PMCID: PMC8281796 DOI: 10.7759/cureus.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Cardiac tamponade is a rare complication following orthotopic liver transplantation (OLT). The incidence and treatment specific to the immediate postoperative OLT patient have never been reported. Here, we describe a case of OLT complicated by coagulopathy and difficult intraoperative pulmonary artery catheter placement with subsequent postoperative hemopericardium resulting in tamponade. An emergent, ultrasound-guided, lateral-apical pericardiocentesis was successfully performed, suggesting a possible procedural technique for pericardiocentesis in the immediate postoperative period for liver transplant patients.
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Affiliation(s)
- Christan D Santos
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, USA
| | - Joshua A Propst
- Department of Transplant Medicine, Mayo Clinic, Jacksonville, USA
| | - Juan M Canabal
- Department of Transplant Medicine, Mayo Clinic, Jacksonville, USA
| | - Rohan M Goswami
- Department of Transplant Medicine, Mayo Clinic, Jacksonville, USA
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Ishida S, Yagami K, Fujita T, Mutsuga M. Pericardioperitoneal and pericardiopleural windows: A drainage technique for the treatment of recurrent cardiac tamponade. A case report. Int J Surg Case Rep 2021; 83:105962. [PMID: 34004564 PMCID: PMC8141763 DOI: 10.1016/j.ijscr.2021.105962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Given that pericardial effusion may sometimes lead to cardiac tamponade and chronic heart failure, its management seems absolutely essential. In case of a poor response to medical therapy, surgical drainage of the effusion is required. Although some drainage procedures for pericardial effusion (e.g., temporary puncture, pericardiopleural drainage, and pericardioperitoneal drainage) are currently used in clinical practice, their long-term efficacy remains unclear. Presentation of case We present a case of a 58-year old female with recurrent pericardial effusion secondary to systemic lupus erythematosus. Since she was relatively young and on steroids, long-term patency of pericardial fenestration needed to be insured without any device. Hence, we created 2 pericardial windows, pericardioperitoneal and pericardiopleural, via a single-incision subxiphoid approach to allow the effusion to drain into the abdominal and thoracic cavities. Discussion It is important to efficiently manage pericardial effusion because it can lead to more serious conditions such as cardiac tamponade and chronic heart failure. Our technique, which involves making a small incision, can reduce the risk of recurrence. Conclusion Simultaneous creation of pericardioperitoneal and pericardiopleural windows is simple and can be feasibly performed to prevent the recurrence of pericardial effusion. Pericardial effusion can lead to cardiac tamponade and chronic heart failure. Drainage procedures for pericardial effusion are currently used in clinical settings. Long-term efficacy of these drainage procedures remains unclear. Pericardioperitoneal and pericardiopleural window techniques prevent pericardial effusion recurrence.
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Affiliation(s)
- Shinichi Ishida
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161, Maebata-cho, Tajimi-City, Gifu 507-8532, Japan.
| | - Kei Yagami
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161, Maebata-cho, Tajimi-City, Gifu 507-8532, Japan
| | - Takashi Fujita
- Department of Cardiac Surgery, Gifu Prefectural Tajimi Hospital, 5-161, Maebata-cho, Tajimi-City, Gifu 507-8532, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-City, Aichi 466-8550, Japan
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Case study-based systematic review of literature on lymphoma-associated cardiac tamponade. Contemp Oncol (Pozn) 2021; 25:57-63. [PMID: 33911983 PMCID: PMC8063898 DOI: 10.5114/wo.2021.103828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compile all the relevant studies of patients presenting with pericardial tamponade before or after diagnosis of lymphoma, describe the clinical presentations of patients with lymphoma and cardiac tamponade, and assess the difference in overall survival based on the timing of cardiac tamponade diagnosis. A comprehensive search strategy was conducted in the following databases: PubMed and Cochrane Library, using the following keywords: Lymphoma AND Cardiac Tamponade. The criteria for eligibility included cases with a confirmed diagnosis of lymphoma and cardiac tamponade, human studies, and publications in English language. The statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. We included 48 research articles (n = 52 cases) with adequate reporting of measured outcomes. The median age of the patients was 52 (9–94) years. Only 6 patients were noted to have primary cardiac lymphoma, while the majority of cases were considered to have secondary cardiac lymphoma (88.5%). According to the data on the type of lymphoma reported through cytology and immunohistochemistry, 49 patients were diagnosed with non-Hodgkin lymphoma, and of these cases the most common subtype was large B-cell lymphoma (42.9%). Overall, the average duration of illness was 14 ± 23 days. A total of 13 patients had distant heart sounds, 12 cases were noted to be hypotensive, and 13 subjects were found to have increased jugular venous pressure. Our retrospective study demonstrated that most patients presented with pericardial tamponade after lymphoma diagnosis, and those were mostly secondary cardiac lymphoma of the non-Hodgkin type with large B-cell as the most common subtype. Dyspnoea, oedema, and constitutional symptoms were the most common presenting signs. The median overall survival of patients with lymphoma and cardiac tamponade is 4 months, with no significant difference in mortality in the presentation timing before and after the diagnosis of lymphoma.
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Imbert N, Tacher V, Mounier R, Martin M. Suspicion of penetrating cardiac injury: Curing or caring? Ann Card Anaesth 2020; 23:361-363. [PMID: 32687101 PMCID: PMC7559970 DOI: 10.4103/aca.aca_214_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/10/2019] [Indexed: 11/16/2022] Open
Abstract
Identifying penetrating cardiac injury in hemodynamically stable patients can be challenging especially when the patient has no signs of cardiac tamponade and no pericardial effusion identified on transthoracic echocardiography. In this case report, we discuss both penetrating cardiac injuries diagnosis algorithm and treatment strategies. At present, it is difficult to refer to general guidelines transposable from one center to another. We report the paramount importance of multidisciplinary management with experienced teams to face any possible pitfalls in traumatology especially in the context of penetrating cardiac injury.
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Affiliation(s)
- Nicolas Imbert
- Surgical Intensive Care Unit, Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Vania Tacher
- Department of Radiology and Medical Imaging, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
- Unité INSERM U955 équipe 18, IMRB, Créteil, France
| | - Roman Mounier
- Surgical Intensive Care Unit, Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Mathieu Martin
- Surgical Intensive Care Unit, Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Paris-Est Créteil University and Assistance-Publique Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
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Evaluation and Treatment of Cardiac Tamponade in a Pregnant Patient. Case Rep Obstet Gynecol 2020; 2020:8703980. [PMID: 32015919 PMCID: PMC6985926 DOI: 10.1155/2020/8703980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiac tamponade is an uncommon but life-threatening emergency that may occur in pregnant women. There is a plethora of causes, but prompt diagnosis and intervention is imperative to optimize both maternal and fetal outcomes. We report on a case of a large pericardial effusion leading to cardiac tamponade occurring in the 32nd week of gestation in a previously healthy woman. Rapid recognition and a multidisciplinary team meeting resulted in a therapeutic pericardial window and drainage and relief of symptoms. The woman underwent an uncomplicated repeat cesarean delivery at term with a positive neonatal outcome. This case highlights the importance of a rapid diagnosis and a team-based approach to managing a complex medical condition like cardiac tamponade in pregnancy.
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Ay Y, Kahraman Ay N. Diagnostic value of transthoracic echocardiography and computerized tomography for surgically confirmed late tamponade after cardiac surgery. J Card Surg 2019; 34:1486-1491. [DOI: 10.1111/jocs.14269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yasin Ay
- Department of Cardiovascular Surgery Bezmialem Vakif University Fatih Istanbul Turkey
| | - Nuray Kahraman Ay
- Department of Cardiology Bezmialem Vakif University Fatih Istanbul Turkey
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Cook S, Cortellini S, Humm K. Retrospective evaluation of pericardial catheter placement in the management of pericardial effusion in dogs (2007-2015):18 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:413-417. [PMID: 31228330 DOI: 10.1111/vec.12862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/27/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of pericardial catheters in dogs with pericardial effusion (PE), and detail any associated adverse events. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Eighteen client-owned dogs that had pericardial catheters placed for pericardial fluid drainage between May 2007 and January 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All pericardial catheters were placed within 5 hours of presentation, usually within 1 hour (median 72.5 min, range 45-300 min). Ten of 18 cases were sedated with butorphanol, and 4 with additional midazolam. Four had pericardial catheters positioned for single drainage only and were immediately removed. The other 14 pericardial catheters remained in situ for a median of 18 hours (range 2-88 h). Ten of the remaining 14 cases were redrained after pericardial catheter placement. The main adverse events reported were new arrhythmias in 6/18 cases, with 4 of these 6 patients being administered anti-arrhythmic therapy. No infectious or functional complications were reported. Ten patients were discharged, 1 died and 7 were euthanized. CONCLUSIONS Thoracic drainage catheters inserted into the pericardial space via a modified-Seldinger technique can be positioned in dogs to aid management of PEs. The main associated adverse event is arrhythmia. Minimal sedation is required for placement, and dogs tend not to require postprocedural analgesia. Catheters can remain in situ for repeated drainage, potentially decreasing staffing time requirement and repeat sedation. Their use is associated with a rate of arrhythmia requiring treatment of 22%, compared to that of needle pericardiocentesis alone at 13%. They are easy to position using equipment available in many facilities.
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Affiliation(s)
- Simon Cook
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Stefano Cortellini
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
| | - Karen Humm
- Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, UK
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Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med 2019; 37:321-326. [DOI: 10.1016/j.ajem.2018.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/17/2018] [Accepted: 11/05/2018] [Indexed: 02/08/2023] Open
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Abstract
Supplemental Digital Content is available in the text. Objective The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade. Background Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally. Methods and results A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications. Conclusion The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
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Abstract
Prevalence of cancer and its various related complications continues to rise. Increasingly these life-threatening complications are initially managed in the emergency department, making a prompt and accurate diagnosis crucial to effectively institute the proper treatment and establish goals of care. The following oncologic emergencies are reviewed in this article: pericardial tamponade, superior vena cava syndrome, brain metastasis, malignant spinal cord compression, and hyperviscosity syndrome.
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Affiliation(s)
- Umar A Khan
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA.
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Kearns MJ, Walley KR. Tamponade: Hemodynamic and Echocardiographic Diagnosis. Chest 2017; 153:1266-1275. [PMID: 29137910 DOI: 10.1016/j.chest.2017.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/24/2017] [Accepted: 11/04/2017] [Indexed: 11/29/2022] Open
Abstract
Cardiac tamponade is a medical emergency that can be readily reversed with timely recognition and appropriate intervention. The clinical diagnosis of cardiac tamponade requires synthesis of a constellation of otherwise nonspecific features based on an understanding of the underlying pathophysiological characteristics. Although echocardiographic examination is a central component of diagnosis, alone it is insufficient to establish the physiological diagnosis of hemodynamically significant cardiac tamponade. The hemodynamic diagnosis of cardiac tamponade requires clinical evidence of low cardiac output and stroke volume in the setting of elevated cardiac filling pressures, with evidence of increased sympathetic tone (eg, tachycardia, peripheral vasoconstriction), and exclusion of other causes of shock as the primary problem (particularly cardiogenic shock). The hemodynamic features of tamponade are revealed by considering the effects of pericardial constraint. Pulsus paradoxus and loss of the normal "y" descent of a jugular venous pressure waveform may be appreciated on clinical examination. When a pulmonary artery catheter is placed, equalization of diastolic pressures across all chambers is observed. Echocardiographic examination confirms the size, location, and other characteristics of the causal pericardial collection. Several echocardiographic features support the hemodynamic diagnosis of tamponade, including early diastolic collapse of the right ventricle, late diastolic collapse of the right atrium, respiratory variation in mitral valve inflow (akin to pulsus paradoxus), and decreased early filling (E wave) of mitral valve inflow (related to loss of the y descent). Echocardiographic examination then supports decisions about the early treatment and drainage of the tamponading effusion.
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Affiliation(s)
- Mark J Kearns
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Keith R Walley
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
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Shyy W, Knight RS, Kornblith A, Teismann NA. Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2197-2201. [PMID: 28503752 DOI: 10.1002/jum.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
The presentation of cardiac tamponade is a spectrum from occult to extreme. The clinical history, physical exam, electrocardiogram, and radiographic findings of tamponade have poor sensitivities and even worse specificities. We use a clinical scenario to demonstrate how point-of-care cardiac ultrasound can diagnose impending cardiac tamponade in a clinically stable patient. The ultrasound finding we recommend is the flow velocity paradoxus, in which respiratory variation causes significant changes in transvalvular inflow velocities, which are exaggerated when tamponade is present. The management of a pericardial effusion depends on its physiologic effect, and point-of-care ultrasound directly measures that effect and expedites patient care.
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Affiliation(s)
- William Shyy
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Roneesha S Knight
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Aaron Kornblith
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Nathan A Teismann
- Department of Emergency Medicine, San Francisco Medical Center, University of California, San Francisco, California, USA
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21
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Assayag M, Abbas R, Chanson N, Perozziello A, Ducrocq G, Alexandra JF, Dossier A, Papo T, Sacre K. Diagnosis of systemic inflammatory diseases among patients admitted for acute pericarditis with pericardial effusion. J Cardiovasc Med (Hagerstown) 2017; 18:875-880. [PMID: 28937580 DOI: 10.2459/jcm.0000000000000576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute pericarditis may be the heralding manifestation of various systemic inflammatory diseases (SIDs). The aim of this study was to identify clinical indicators for SIDs in patients admitted for acute pericarditis with pericardial effusion. METHODS All consecutive adult patients hospitalized in a Department of Internal Medicine over a 10-year period for acute pericarditis with pericardial effusion were retrospectively reviewed. Patients with cancer and tuberculosis were excluded. A structured clinical panel for extra-cardiac symptoms of SIDs was applied. SIDs were classified using current international criteria. RESULTS Ninety-nine patients were admitted for acute pericarditis with pericardial effusion. After exclusion, 74 (49.7 ± 19.7 years, 56.7% women) patients were analyzed. Among them, 23 (23.2%) patients had a SID that was revealed by pericarditis in 12 cases. Systemic lupus erythematosus, undifferentiated connective-tissue disease, and Sjogren's syndrome accounted for 75% of the SID. Patients with SIDs were younger (P < 0.001), more frequently of female sex (P = 0.025), and had a higher frequency of extra-cardiac symptoms (P < 0.001) including arthralgia, myalgia, Raynaud phenomenon, and skin rash, as compared with patients with idiopathic pericarditis (n = 51). Overall, after exclusion of neoplasm and tuberculosis, the probability of SIDs in patients admitted with an acute pericarditis with pericardial effusion was 89.7% in patients younger than 50 who had extra-cardiac symptoms. Conversely, the probability fell to 8.4% in patients older than 50 with no extra-cardiac symptoms. CONCLUSION Both age and extra-cardiac symptoms suggest an underlying SID as a possible cause of acute pericarditis.
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Affiliation(s)
- Maureen Assayag
- aDépartement de Médecine Interne bDépartement d'Epidémiologie et Recherche Clinique cDépartement d'Information Médicale dDépartement de Cardiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris eINSERM U1149 fDépartement Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
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22
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Raut MS, Maheshwari A, Dubey S, Shivnani G. Effect of lateral position on localised tamponade. J Cardiothorac Vasc Anesth 2016; 31:e22-e23. [PMID: 27838200 DOI: 10.1053/j.jvca.2016.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sumir Dubey
- Department of Cardiac Surgery, Sir Ganga Ram Hospital New Delhi, India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital New Delhi, India
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Saranteas T, Mavrogenis AF, Mandila C, Poularas J, Panou F. Ultrasound in cardiac trauma. J Crit Care 2016; 38:144-151. [PMID: 27907878 DOI: 10.1016/j.jcrc.2016.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022]
Abstract
In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening. Ultrasound of the heart using transthoracic and transesophageal echocardiography are valuable diagnostic tools that can be used interchangeably in conjunction with other modalities such as the electrocardiogram and computed tomography for the diagnosis of cardiovascular abnormalities in trauma patients. Although ultrasound of the heart is often underused in the setting of trauma, it does have the advantages of being easily accessible, noninvasive, and rapid bedside assessment tool. This review article aims to analyze the potential cardiac injuries in trauma patients, and to provide an elaborate description of the role of echocardiography for their accurate diagnosis.
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Affiliation(s)
- Theodosios Saranteas
- Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christina Mandila
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - John Poularas
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - Fotios Panou
- Second department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Computed tomography-guided pericardiocentesis – A single-center experience. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Neves D, Silva G, Morais G, Ferreira N, Carvalho M, Gama Ribeiro V, Bettencourt N. Computed tomography-guided pericardiocentesis – A single-center experience. Rev Port Cardiol 2016; 35:285-90. [DOI: 10.1016/j.repc.2015.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022] Open
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The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal. BIOMED RESEARCH INTERNATIONAL 2015; 2015:596451. [PMID: 26605333 PMCID: PMC4641179 DOI: 10.1155/2015/596451] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 10/18/2015] [Indexed: 01/22/2023]
Abstract
Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.
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27
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El-Husseini W, Pravečková A, Kočková R, Marek T, Frídl P, Kautzner J. Pericardiocentesis guided by echocardiography performed in echocardiography laboratory - Safety profile of the single centre prospective registry. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Gouriet F, Levy PY, Casalta JP, Zandotti C, Collart F, Lepidi H, Cautela J, Bonnet JL, Thuny F, Habib G, Raoult D. Etiology of Pericarditis in a Prospective Cohort of 1162 Cases. Am J Med 2015; 128:784.e1-8. [PMID: 25770033 DOI: 10.1016/j.amjmed.2015.01.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pericarditis is a common disorder that is present in various pathologies and may be the first manifestation of an underlying systemic disease. The aims of this study were to describe the different causes of infectious and noninfectious pericarditis and compare them with those in the literature. METHODS Between May 2007 and September 2012, we prospectively evaluated a strategy using a systematic prescription of tests for the different etiological causes of pericarditis in patients with acute pericarditis who were hospitalized in the Cardiology and Cardiac Surgery Department or admitted to the Emergency Department (University Hospital of Marseille). A total of 1162 patients with suspected pericarditis were included. A standardized diagnosis procedure was performed for 800 patients, and 362 had pericardiocentesis. RESULTS Acute pericarditis was diagnosed in 933 patients. No diagnosis was established in 516 patients (55%), 197 patients suffered from postinjury syndromes, and 156 had previously known diseases that were associated with pericarditis. Our survey allowed us to relate the probable cause of pericarditis in 64 cases. An infectious etiological diagnosis was established in 53 cases. In our study, postinjury syndrome was the leading cause of pericarditis, a new diagnosis was made in 6.7% of cases, and 16% of the diagnoses were linked to a secondary, underlying disease. CONCLUSION Using this strategy, we were able to reduce the number of idiopathic cases. In many cases, the etiologies were still identified. Long-term follow-up in the management of idiopathic pericarditis should remain of great interest for the future diagnosis of other disorders that remain hidden.
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Affiliation(s)
- Frédérique Gouriet
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Pierre-Yves Levy
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Jean-Paul Casalta
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Christine Zandotti
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Frédéric Collart
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Hubert Lepidi
- Département d'anathomopathologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Jennifer Cautela
- Département de Cardiologie, Hôpital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Jean Louis Bonnet
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Franck Thuny
- Département de Cardiologie, Hôpital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
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McIntyre WF, Jassal DS, Morris AL. Pericardial Effusions: Do They All Require Pericardiocentesis? Can J Cardiol 2015; 31:812-5. [DOI: 10.1016/j.cjca.2015.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/24/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022] Open
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Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, Pepi M, Ristic A, Imazio M, Paelinck B, Lancellotti P. European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging 2014; 16:12-31. [PMID: 25248336 DOI: 10.1093/ehjci/jeu128] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although pericardial diseases are common in the daily clinical practice and can result in a significant morbidity and mortality, imaging of patients with suspected or known pericardial disorders remain challenging. Multimodality imaging is part of the management of pericardial diseases. Echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance are often used as complementary imaging modalities. The choice of one or multiple imaging modalities is driven by the clinical context or conditions of the patient. The scope of the present document is to highlight the respective role of each technique according to the clinical context in the diagnosis and management of pericardial diseases.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Sven Plein
- The Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Petros Nihoyanopoulos
- Department of Cardiology, Imperial College, NHLI Hammersmith Hospital London, London, UK
| | - Otto Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany
| | - Maria Joao Andrade
- Department of Cardiology, Hospital Santa Cruz, Instituto Cardiovascular de Lisboa, Lisboa, Portugal
| | - Mauro Pepi
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, Belgrad, Serbia
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Bernard Paelinck
- Cardiac Imaging, Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium
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Abstract
Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.
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Abstract
Prevalence of cancer and its various related complications continues to rise. Increasingly these life-threatening complications are initially managed in the emergency department, making a prompt and accurate diagnosis crucial to effectively institute the proper treatment and establish goals of care. The following oncologic emergencies are reviewed in this article: pericardial tamponade, superior vena cava syndrome, brain metastasis, malignant spinal cord compression, and hyperviscosity syndrome.
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Affiliation(s)
- Umar A Khan
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD 21201, USA.
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Unlüer EE, Karagöz A. Red flags in bedside ultrasonography for surgical cases. Interv Med Appl Sci 2013; 5:85-8. [PMID: 24265896 DOI: 10.1556/imas.5.2013.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/29/2013] [Indexed: 11/19/2022] Open
Abstract
Bedside ultrasonography is highly accurate in evaluating hypotension, even if performed by nonradiologist. Here we report three cases presenting with hypotension to the trauma room. In the first case, limited bedside ultrasonography demonstrated dilatation of the inferior vena cava and loss of respiratory variation in diameter. In further evaluation, dilated aortic root, massive pericardial effusion, collapse of right heart chambers, and a dissection flap at the anterior wall of base of ascending aorta were detected. With these findings, the patient was sent to the operation room with a diagnosis of DeBakey type 2 aortic dissection in approximately 15 min. In the second case, bedside ultrasonography demonstrated absence of pleural movements and comet tail artifacts on the right lung region of the patient. Together with deterioration of the vital signs, the patient was diagnosed as right-sided pneumothorax and underwent the tube thoracostomy. In the third case, bedside ultrasonography revealed the presence of free fluid in Morrison's pouch and splenorenal space in a hypotensive patient with a blunt abdominal trauma. He was consulted with general surgery department and was sent to the operation room without further diagnostic evaluation. In these cases, we emphasized the key role of bedside ultrasonography in hypotensive patients.
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Affiliation(s)
- Erden Erol Unlüer
- Izmir Katip Çelebi University Atatürk Research and Training Hospital Izmir Turkey
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L'italien AJ. Critical cardiovascular skills and procedures in the emergency department. Emerg Med Clin North Am 2013. [PMID: 23200332 DOI: 10.1016/j.emc.2012.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The management of cardiovascular emergencies is a fundamental component of the practice of an emergency practitioner. Delays in the evaluations and management can lead to significant morbidity or mortality. It is of vital importance to be familiar with procedures such as pericardiocentesis, cardioversion, defibrillation, temporary pacing, and options for the management of tachyarrhythmias. This article discusses the most common cardiovascular procedures encountered in an emergency setting, including the indications, contraindications, equipment, technique, and complications for each procedure.
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Affiliation(s)
- Anita J L'italien
- Department of Emergency Medicine, Wake Emergency Physicians, PA, 3000 New Bern Avenue, Medical Office Building, Raleigh, NC 27610, USA. l'
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Abstract
OBJECTIVES To provide an up-to-date review of current literature on the pathophysiology, diagnosis, and management of five key malignancy-related complications: superior vena cava syndrome, malignant pericardial effusion, malignant spinal cord compression, hypercalcemia, and acute tumor lysis syndrome. DATA SOURCES Database searches and review of relevant medical literature. DATA SYNTHESIS Malignancy-related complications demand increased attention from intensivists due to their frequency and increasing cancer prevalence. Although such complications portend a poor prognosis, proper acute management can improve short-term outcomes by facilitating either definitive care of the underlying malignancy or the institution of appropriate palliative measures. CONCLUSIONS Knowledge of malignancy-induced complications in critically ill patients expedites the ability of the intensivist to properly manage them. Five complications commonly requiring emergency management are addressed in this review. Specifically, superior vena cava syndrome may warrant radiation, chemotherapy, vascular stenting, or surgical resection. Malignant pericardial effusion may require emergency pericardiocentesis if cardiac tamponade develops. Malignant spinal cord compression demands immediate spinal imaging, glucocorticoids, and either surgery or radiation. Hypercalcemia requires aggressive intravenous hydration and a bisphosphonate. Acute tumor lysis syndrome necessitates intravenous hydration, rasburicase, and management of associated electrolyte abnormalities.
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36
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Greenhalgh DL, Patrick MR. Perioperative transoesophageal echocardiography: past, present & future. Anaesthesia 2012; 67:343-6. [DOI: 10.1111/j.1365-2044.2012.07103.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Loukas M, Walters A, Boon J, Welch T, Meiring J, Abrahams P. Pericardiocentesis: A clinical anatomy review. Clin Anat 2012; 25:872-81. [DOI: 10.1002/ca.22032] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/20/2011] [Accepted: 12/19/2011] [Indexed: 11/08/2022]
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Abstract
Emergency echocardiography refers to the use of cardiac ultrasound to address critical and time-sensitive clinical questions during the initial evaluation and treatment of the critically ill patient presenting to the emergency department. The information obtained can be pivotal to a physician's clinical decision making and can guide further diagnostic or therapeutic interventions. This article provides an evidence-based discussion of the common uses of emergency transthoracic echocardiography, as well as its benefits and limitations in the current practice of emergency medicine.
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Carmona P, Mateo E, Casanovas I, Peña JJ, Llagunes J, Aguar F, De Andrés J, Errando C. Management of cardiac tamponade after cardiac surgery. J Cardiothorac Vasc Anesth 2011; 26:302-11. [PMID: 21868250 DOI: 10.1053/j.jvca.2011.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 01/27/2023]
Affiliation(s)
- Paula Carmona
- Anaesthesia, Critical Care and Pain Medicine Department, Consorcio Hospital General of Valencia, Valencia, Spain.
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A case of coagula tamponade 4 years after Bentall procedure. J Echocardiogr 2011; 9:79-80. [PMID: 27276886 DOI: 10.1007/s12574-010-0070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 11/27/2022]
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Abstract
Ultrasound applications in perioperative medicine have expanded enormously over the past decade. Transoesophageal echocardiography has been performed by anaesthetists during cardiac surgery for over 20 years. With the increasing availability of portable ultrasound systems, the use of ultrasound to assist in vascular cannulation and regional anaesthesia has been well described. Portable ultrasound systems come with a range of probes for different applications, including transthoracic echocardiography. While transthoracic echocardiography has traditionally been the domain of cardiologists, its use has been increasing in critical care, the emergency room and, recently, by anaesthetists in the perioperative period. Unlike formal cardiology-based transthoracic echocardiography, focused, goal-directed transthoracic echocardiography is often more appropriate in the perioperative period to address a particular question and can be performed in just a few minutes. Transthoracic echocardiography allows rapid, noninvasive, point-of-care assessment of ventricular function, valvular integrity, volume status and fluid responsiveness. It can help distinguish undifferentiated systolic murmurs preoperatively, give valuable information on the aetiology of unexplained hypotension and cardiovascular collapse and assess response to therapeutic interventions such as vasoactive drugs and volume resuscitation. Focused transthoracic echocardiography should include qualitative assessment of left and right ventricular function, an estimate of aortic valve gradient, right ventricular systolic pressure and intravascular volume status as minimum requirements. Transthoracic echocardiography is a valuable tool in the perioperative period and ideally the equipment and expertise should be available in all operating rooms.
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Affiliation(s)
- B. S. Cowie
- Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Doniger SJ. Bedside emergency cardiac ultrasound in children. J Emerg Trauma Shock 2010; 3:282-91. [PMID: 20930974 PMCID: PMC2938495 DOI: 10.4103/0974-2700.66535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 04/24/2010] [Indexed: 02/02/2023] Open
Abstract
Bedside emergency ultrasound has rapidly developed over the past several years and has now become part of the standard of care for several applications. While it has only recently been applied to critically ill pediatric patients, several of the well-established adult indications may be applied to pediatric patients. One of the most important and life-saving applications is bedside echocardiography. While bedside emergency ultrasonography does not serve to replace formal comprehensive studies, it serves as an extension of the physical examination. It is especially useful as a rapid and effective tool in the diagnosis of pericardial effusions, tamponade and in distinguishing potentially reversible causes of pulseless electrical activity from asystole. Most recently, left ventricular function and inferior vena cava measurements have proven helpful in the assessment of undifferentiated hypotension and shock in adults and children. Future research remains to be carried out in determining the efficacy of bedside ultrasonography in pediatric-specific pathology such as congenital heart disease. This article serves as a comprehensive review of the adult literature and a review of the recent applications in the pediatric emergency department. It also highlights the techniques of bedside ultrasonography with examples of normal and pathologic images.
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Affiliation(s)
- Stephanie J Doniger
- Department of Emergency Medicine, Children’s Hospital & Research Center, Oakland 747, 52 Street, Oakland CA 94609
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Eichler K, Zangos S, Thalhammer A, Jacobi V, Walcher F, Marzi I, Moritz A, Vogl TJ, Mack MG. CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome. Eur J Radiol 2010; 75:28-31. [DOI: 10.1016/j.ejrad.2010.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
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Abstract
Oncologic emergencies represent a wide variety of conditions that can occur at any time during the course of a malignancy, from an initial presenting manifestation in someone with an undiagnosed cancer, to end-stage incurable metastatic disease. Emergent conditions can also arise after a malignancy has been in remission for many years, even decades, so clinicians must be aware of any prior history of cancer in patients. Oncologic emergencies include conditions caused by the cancer itself or side effects of therapy. Emergent conditions include metabolic, cardiac, neurologic, or infectious disorders. Many of these emergencies are imminently life-threatening, and can occur in patients with curable disease (such as lymphomas or leukemias); however, many also present in patients with incurable advanced disease. Prompt recognition and treatment of these conditions can lead to markedly improved quality and quantity of life.
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Affiliation(s)
- Deepti Behl
- Hematology and Oncology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Magnetic resonance is known to be a superior modality for the evaluation of pericardial disease and intracardiac masses because of its unmatched capacity for tissue characterization and high spatial resolution. New real-time sequences complement the standard morphologic imaging of the pericardium with dynamic image acquisitions that also can provide hemodynamic information indicative of constriction. Magnetic resonance also is becoming increasingly recognized as a superior modality for the detection and characterization of intracardiac thrombus. This article reviews the use of magnetic resonance imaging for the evaluation of pericardial disease and the detection of intracardiac thrombus, with particular emphasis on the newer pulse sequences currently available for cardiac imaging.
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Affiliation(s)
- John D Grizzard
- Non-invasive Cardiovascular Imaging, Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0615, USA.
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Pericardial Effusion, Tamponade, and Constriction. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chatterjee K, McGlothlin D, Michaels A. Analytic reviews: cardiogenic shock with preserved systolic function: a reminder. J Intensive Care Med 2008; 23:355-66. [PMID: 18794166 DOI: 10.1177/0885066608324250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although cardiogenic shock, whether acute or chronic, most frequently results from depressed left ventricular systolic function, the same syndrome can occur in patients with preserved systolic function. The etiologies and the pathophysiology of the syndrome of cardiogenic shock with preserved ejection fraction are distinctly different from those with reduced ejection fraction. The therapeutic approaches are also different. The prognosis of the patients with acute subset of this syndrome is very favorable, provided prompt diagnosis is made and appropriate treatment is provided. In this review, the important causes, pathophysiology, diagnosis, and therapies of patients with "cardiogenic shock with preserved ejection fraction'' are discussed.
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Affiliation(s)
- Kanu Chatterjee
- Division of Cardiology, Department of Medicine, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Misselt AJ, Harris SR, Glockner J, Feng D, Syed IS, Araoz PA. MR imaging of the pericardium. Magn Reson Imaging Clin N Am 2008; 16:185-99, vii. [PMID: 18474326 DOI: 10.1016/j.mric.2008.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Imaging of the pericardium requires understanding of anatomy and the normal and abnormal physiology of the pericardium. MR imaging is well-suited for answering clinical questions regarding suspected pericardial disease. Pericardial diseases that may be effectively imaged with MR imaging include pericarditis, pericardial effusion, cardiac-pericardial tamponade, constrictive pericarditis, pericardial cysts, absence of the pericardium, and pericardial masses. Although benign and malignant primary tumors of the pericardium may be occasionally encountered, the most common etiology of a pericardial mass is metastatic disease.
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Affiliation(s)
- Andrew J Misselt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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