P-LUM-18: Beyond the gastrointestinal tract: A case report of an endoscopic ultrasound-guided pericardial drainage

BACKGROUND AND OBJECTIVES: The role of endoscopic ultrasound-guided fine needle aspiration (EUS FNA) for mediastinal lesions has long been recognized, but case reports on pericardial aspiration ± biopsy and biopsy of intra-cardiac lesions are also increasingly being described. A 58-year-old female with a history of left breast carcinoma underwent a mastectomy with chemoradiotherapy in 2008. She had a tumor recurrence in 2014 with malignant pleural and pericardial effusions. A transthoracic pericardiocentesis (TTP) was done once in November 2015 for symptomatic pericardial effusion. In March 2016, she presented with progressive dyspnea. A transthoracic echocardiograph showed a posteriorly located pericardial effusion (29 mm) with diastolic collapse of the right atrium. She was unsuitable for both TTP (due to poor window) and pericardial fenestration (in view of the history of pleurodesis, previous thoracic instrumentation, and poor prognosis). Therefore, a transesophageal drainage with EUS scope was performed. METHODS AND RESULTS: The pericardial sac was punctured with a 19-gauge needle (EchoTip(®), Cook Medical) and 245 ml of hemorrhagic fluid was aspirated. There were no immediate or late complications. The patient experienced symptomatic improvement, significant reduction in the size of the pericardial effusion, and absence of diastolic right atrial collapse. She remained asymptomatic with no recurrence of effusion. She died 5 months later from pneumonia. CONCLUSIONS: EUS-guided pericardiocentesis may be an alternative for TTP in selected cases.