Coronary sinus diameter to inferior vena cava diameter ratio in the diagnosis of cardiac tamponade: a novel approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E.H Ozcan Cetin ◽  
M.S Cetin ◽  
B Tekin Tak ◽  
F.A Ekizler ◽  
F Ozcan ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Coronary Sinus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Area Under The Curve ◽  
Right Atrial ◽  
P Value ◽  
Large Pericardial Effusion

Abstract Background and aim Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion. Materials and methods 66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p<0.001) and 35% lower CS/IVC ratio (20.7±5.5 vs 34.7±10.5% p<0.001).After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade respectively. (Nagelkerke r square value for CS diameter was 53.7% and 72.1% for CS/IVC ratio). 1 mm increase in CS diameter and 1% increase in CS/IVC ratio were associated with an increased odds ratio of 59% and 39% in predicting tamponade, respectively (p value <0.001).In ROC analysis, a cut of value of 6.85 mm for CS diameter, had 82.6% sensitivity and 83.7% specificity for predicting cardiac tamponade (Area under the curve 0.879, p<0.001). Additionally, a cut of value of 27% for CS / IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade (Area under the curve 0.945, p<0.001). Conclusion The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade Figure 1 Funding Acknowledgement Type of funding source: None

Coronary Sinus Diameter to Inferior Vena Cava Diameter Ratio in the Diagnosis of Cardiac Tamponade: A Novel Approach

2020 ◽  
Vol 44 (4) ◽  
pp. 599-604
Author(s):  
Elif Hande Ozcan Cetin ◽  
Mehmet Serkan Cetin ◽  
Hasan Can Könte ◽  
Bahar Tekin Tak ◽  
Firdevs Aysenur Ekizler ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Coronary Sinus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Diameter Ratio ◽  
Novel Approach ◽  
Inferior Vena Cava Diameter

Pericardial effusion: Diagnostic value of the subcostal acoustic window (inferior vena cava-right atrial projection)

1987 ◽  
Vol 10 (4) ◽  
pp. 261-266 ◽  
Author(s):  
J. Candell-Riera ◽  
H. Garc-a-del-castillo ◽  
G. Permanyer-Miralda ◽  
J. Soler-Soler
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Diagnostic Value ◽  
Right Atrial ◽  
Acoustic Window

scholarly journals Mediastinal effusion due to pericardiocentesis with cardiac tamponade: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Zhang ◽  
Difen Wang ◽  
Ying Liu
Keyword(s):  
Computed Tomography ◽  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Inferior Vena Cava Filter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Vena Cava Filter ◽  
Complication Rates ◽  
Bleeding Tendency

Abstract Background Pericardiocentesis is an effective treatment for cardiac tamponade, but there are risks, including haemorrhagic events, cardiac perforation, pneumothorax, arrhythmia, acute pulmonary oedema and so on. Mediastinal effusion caused by puncture is rarely reported. Case presentation A 47-year-old man who had a history of right leg deep vein thrombosis and pulmonary artery embolism with implantation of an inferior vena cava filter presented for inferior vena cava filter removal. Within 30 min after the procedure, he developed chest pain, nausea, vomiting and presyncope with shock. Echocardiography confirmed massive pericardial effusion with evidence of cardiac tamponade. Emergency pericardiocentesis was performed. Confusingly, only 3 mL of bloody pericardial effusion was drained in total, and subsequently, the patient’s symptoms rapidly improved with stable haemodynamics. Repeat echocardiography showed that the pericardial effusion had disappeared. Urgent computed tomography pulmonary angiography demonstrated localized effusion, which was not seen the previous computed tomography results and was noted around the left ventricle in the mediastinal apace. No intervention was performed, given that there was no bleeding tendency or further adverse events related to the mediastinal effusion. The patient was subsequently discharged in a stable condition a few days later, and outpatient follow-up was advised. Conclusions Mediastinal effusion is a rare complication of pericardiocentesis. In the case described herein, the most likely cause was pericardial effusion extravasated into the mediastinum through the needle insertion site in the puncture process due to large pressure variations in the intrapericardial space with tamponade, differing from cases of over-anticoagulation reported in the previous literature. Just as our case demonstrates that conservative treatment of an hemodynamic insignificant mediastinal effusion may be appropriate. Echocardiography is useful and effective to minimize complication rates.

scholarly journals P172 Uncommon reason for right-sided heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Z Mladenovic ◽  
S O Obradovic ◽  
I R Ilic ◽  
D J L J Djenic ◽  
V D Vranes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lateral Wall ◽  
Middle Part ◽  
Right Atrial ◽  
Bleeding Complications

Abstract This paper outlines a case study 57 year old, female patient who was admitted in our institution due to severe sign and symptoms of right-sided heart failure. She complained on progressive fatigue, a shortness of breath and oedema of cruris for three months before. Initially she was hospitalized in regional hospital due to pericardial effusion and they excluded any malignancy and systemic tissue disease in that moment. Immediately after admission we have performed 2D transthoracic echocardiography which showed a large (6.7x4.9cm), oval tumours soft tissue formation in right atrium which compromise flow in Vena cava inferior and across tricuspid valve and make a gradient of 35 mmHg above it. Left and right ventricles had preserved dimensions and function, without pericardial effusion. 3D transoesophageal echocardiography (TEE) imaged confirmed huge, oval tumorous formation (8.2x7.9cm), which originated from lateral wall of right atrium and almost occupied it, compromising flow towards superior and inferior vena cava. We had detected an irregular free space, probably due to necrosis, in the middle part of that tumorous formation. Thorax MSCT revealed heterogeneous expansive mass (19x8x8 cm) in projection of right atrium with signs of active bleeding its central part, although MSCT couldn’t exclude extra cardiac origin. There were no signs of dissemination. Cardiac MR indicated that we had extra cardiac mass (12x9x10cm) close to lateral right atrial wall and basal part of lateral wall of right ventricle which compromise flow towards superior and inferior vena cava, with no changes on surrounding structures. The patient underwent almost complete tumour surgical resection, with a lot of bleeding complications due to its local invasiveness and central necrosis. Surgical findings completely were concordant with 3D TEE imagining which provided us very precise information about size, location and extension of tumour. Severe systemic inflammatory response syndrome (SIRS) occurred in the postoperative period, and the patient died due to multiple organ dysfunction. Patohistological analyses were conclusive of undifferentiated pleomorphic sarcoma diagnosis. Abstract P172 Figure.

scholarly journals P646 Cardiac tamponade as initial manifestation of small cell lung carcinoma

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M-C-T Murdila ◽  
B Zamfirescu ◽  
A C Popescu
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Vena Cava ◽  
Small Cell ◽  
Right Atrial ◽  
Thoracic Wall ◽  
Respiratory Variation ◽  
Initial Manifestation ◽  
Cell Lung Carcinoma ◽  
Large Pericardial Effusion

Abstract We report the case of a 69 years old woman, ex-smoker, with a history of hypertension, dyslipidemia, diabetes and right leg partial amputation after childhood osteomyelitis, presented at the emergency department for dyspnoea, posterior thoracic pain and progressive distention of the abdomen. She was tachycardic, slightly hypoxemic but normotensive. Electrocardiography: sinus tachycardia, normal axis, diffuse microvoltage and electric alternans. Chest X-ray showed enlarged cardiac silouhette, bilateral pleural effusion and upper right pulmonary lobe consolidation. Transthoracic echocardiography revealed large pericardial effusion, swinging heart, right atrial and right ventricular colapse, significant respiratory variation of transmitral and transtricuspidian flow, dilated inferior vena cava without respiratory variation, all suggesting cardiac tamponade. Computed tomography showed a mediastinal and pulmonary mass in the upper right pulmonary lobe, invading the posterior right thoracic wall and multiple mediastinal voluminous lymphadenopaty and ascites. She became hypotensive and was transferred to a tertiary hospital for urgent drainage of pericardial effusion. Over 1200 mL of serohematic fluid was evacuated with the removal of the drainage catheter in the following 48 hours. A biopsy was performed through bronchoscopy and small cell carcinoma of the lung was diagnosed. Considering the advanced stage of the carcinoma the option of pallative treatment was pursued. Discussions Chronic accumulation of large amounts of pericardial fluid is well tolerated, especially in patients that have limited physical activity. Ecocardiography allows early detection of cardiac tamponade. Development of cardiac tamponade in the evolution of malignancy confers a poor prognosis. The particularity of the case Cardiac tamponade as initial manifestation of lung cancer is a very rare occurrence and only limited data exist in literature. Conclusion Simultaneous presence of ascites, pleural and pericardial effusion should rise the suspicion of malignancy. Abstract P646 Figure.

scholarly journals Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Anas Abudan ◽  
Brent Kidd ◽  
Peter Hild ◽  
Bhanu Gupta
Keyword(s):  
Inferior Vena Cava ◽  
Heart Transplantation ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Case Series ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Orthotopic Heart Transplantation ◽  
Eustachian Valve

Abstract Background Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. Case summary Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. Discussion Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.

scholarly journals Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sneha R. Gadi ◽  
Benjamin K. Ruth ◽  
Alan Johnson ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Unusual Presentation ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Common Phenomenon ◽  
Right Heart

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

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