A New Endobronchial Ultrasound (EBUS) Application for Benign and Malignant Pericardial Effusion (PE) Aspiration: Transbronchial Pericardial Effusion Aspiration (TPEA) with a Regular EBUS Transbronchial (TBNA) Needle under Apneic Nasal Jet-Catheter Ventilation
1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany.
2. Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
3. Department of General, Thoracic and Vascular Surgery, ''Fuerth Hospital'', University of Erlangen, Fuerth, Germany;
4. Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany.
5. Professor and Vice-Chairman Co-Director: Thoracic Oncology Department of Medicine, University of Tennessee Graduate School of Medicine 1924 Alcoa Highway, U114 Knoxville, TN 37920, USA.
6. Director of Interventional Pulmonology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
7. CardioThoracic Surgery Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, Greece.
8. Department of Respiratory Diseases, Changhai Hospital/First Affeliated Hospital of the Secondary Military Medical University, Shanghai, China.
Background: Endobronchial Ultrasound (EBUS) is a state of the art diagnostic tool for the pulmonary physicians, especially for the diagnosis and staging of lung cancer. Pericardial effusion (PE) is examined regularly when either hemodynamic impairment occurs or the ventral PE seems to be at least of 2cm distance on echocardiography. Standard approach is the anterior pericardiocentesis. PE of less than 2cm is not approached in general. Objective: We sought to examine minimal invasively PE in an earlier stage with an aspiration through a regular EBUS-TBNA needle. Due to gravitation posterior PEs are earlier detectable than anterior PEs in a patient supine. Method: Although posterior PE is a contradiction for the standard approach used by cardiologists we punctured the PE from the distal left main or proximal lower lobe bronchus. For the first time we describe our algorithm of Transbronchial PE Aspiration (TPEA) by the usage of a regular EBUS-TBNA needle aspiration controlled by C-arm and regular transthoracic ultrasound. Results: We performed TPEA in deep sedation under nasal jet-ventilation in 10 patients without any severe complications even in anterior PE smaller than 20mm for early diagnosis and in some cases even for treatment in regards to hemodynamics. For the post-puncture period of follow-up over 60 days none of these patients had to be punctured again. Conclusion: Although TPEA is an uncommon and possibly more risky approach than the regular anterior pericardiocentesis it may give a chance to interventional pulmonologists to diagnose PE earlier than achieved by anterior transthoracic ultrasound. At the same time TPEA could offer a new window to the heart for several treatment options beside an effusion retrieval. We additionally build the bridge to possible other applications in different areas in future.
Keywords: pericardial effusion, C-arm, endobronchial ultrasound.