Transthoracic ultrasonography is an alternative to subxyphoid ultrasonography for the diagnosis of hemopericardium in penetrating precordial trauma

• Published in: The American journal of surgery 2000-01, Vol.179 (1), p.34-36
• Main Authors: Carrillo, Eddy H, Guinn, Brett J, Ali, Ahsan T, Boaz, Phillip W
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Injuries - complications; Abdominal Injuries - diagnostic imaging; Biological and medical sciences; Cardiac Tamponade - diagnostic imaging; Cardiac Tamponade - etiology; Cardiovascular system; Diagnosis; Diagnostic systems; Emphysema; Fractures; Heart; Heart diseases; Humans; Injuries of the thorax. Foreign bodies. Diseases due to physical agents; Intraoperative Care - methods; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Pain; Patients; Pericardial Effusion - diagnostic imaging; Pericardial Effusion - etiology; Pericardium; Surgeons; Tamponade; Thoracic Injuries - complications; Thoracic Injuries - diagnostic imaging; Trauma; Traumas. Diseases due to physical agents; Ultrasonic imaging; Ultrasonic investigative techniques; Ultrasonography - methods; Ultrasound; Visualization; Wounds, Penetrating - complications; Wounds, Penetrating - diagnostic imaging
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00268-8

Background: Surgeon-performed ultrasonography is increasingly becoming part of the initial evaluation of patients after blunt or penetrating trauma. Currently, most institutions obtain a subxyphoid or subcostal view of the heart and pericardial space, and a three-view ultrasonogram of the abdomen to detect blood in the pericardial sac or in three dependent abdominal areas. Methods: A left parasternal standard transverse transthoracic view is described in addition to the aforementioned views. This facilitates the visualization of the pericardial sac when a subxyphoid or subcostal view cannot be obtained because of anatomical reasons (narrow subxyphoid space) or local factors (pain, fractures, subcutaneous emphysema, or chest wall contusion). Results: The transthoracic view can be useful in patients where the subxyphoid view is difficult to obtain through the conventional approach. In most patients an excellent view of the pericardial sac and ventricles can be obtained and, therefore, expedites the diagnosis and treatment of patients with hemopericardium. Conclusion: Surgeon-performed ultrasonography has become the diagnostic test of choice for patients suspected of having hemopericardium and cardiac tamponade. Transthoracic ultrasonography is an excellent alternative for those patients where a subxyphoid or subcostal view to visualize the pericardial sac and heart cannot be obtained owing to local or anatomical factors.