ABSTRACT The case of a 10-year-old Golden Retriever dog treated at the ASMEVET veterinary hospital in the city of Tunja, Colombia is presented. The owner reported that the patient had an intermittent cough for 2 months. The physical examination revealed the patient to be hyperactive, body condition 4/5, and faint heart sounds. Echocardiography, chest xray, and electrocardiogram were performed, revealing pericardial effusion, increased size of the cardiac silhouette, and deviation of the S-T segment. Initially, treatment was attempted with antibiotics, diuretics and anti-inflammatory agents, without a favourable response. Two months later, it was necessary to perform emergency pericardiocentesis due to cardiac tamponade, and partial subphrenic pericardiectomy. Histopathological analysis revealed a paraganglioma. The patient survived 673 days after surgical treatment.

RESUMEN Se presenta el caso de un canino de 10 años de edad, raza Golden Retriever, atendido en el hospital veterinario ASMEVET en la ciudad de Tunja, Colombia. El propietario reportó que el paciente tubo tos intermitente desde hace 2 meses. Al examen físico se evidencia al paciente hiperactivo, condición corporal 4/5, y con sonidos cardíacos apagados. Se realiza ecocardiografía, radiografía de tórax, y electrocardiograma, encontrando efusión pericárdica, aumento de tamaño de la silueta cardiaca y desviación del segmento S-T. Inicialmente se intentó tratar con antibiótico, diurético y antiinflamatorio, sin respuesta favorable. Dos meses después fue necesario realizar pericardiocentesis de urgencia por el taponamiento cardíaco, y pericardiectomía subfrénica parcial. El análisis histopatológico dio como resultado un paraganglioma. El paciente logra sobrevivir 673 días después del tratamiento quirúrgico.

Abstract Background: Cancer screening is absolutely necessary in patients with pericardial effusion, given that cancer is one of the most serious diseases in the etiology of pericardial effusion. In previous studies, it was stated that the systemic immune-inflammation index (SII); the prognostic nutrition index (PNI); and the hemoglobin, albumin, lymphocyte, platelet (HALP) score can produce scores related to cancer. Objectives: This study began considering that these scoring systems could predict cancer in the etiology of patients with pericardial effusion. Methods: This study produced a retrospective analysis of patients who underwent pericardiocentesis between 2006 and 2022. Pericardiocentesis was performed in a total of 283 patients with moderate-to-large pericardial effusion or pericardial tamponade within the specified period. HALP, PNI, and SII scores were calculated according to the peripheral venous blood taken before the pericardiocentesis procedure. The statistical significance level was set at p<0.05. Results: The HALP score proved to be 0.173 (0.125-0.175) in cancer patients and 0.32 (0.20-0.49) in non-cancer patients (p<0.001). The PNI score proved to be 33.1±5.6 in cancer patients and 39.8±4.8 in non-cancer patients (p<0.001). Conclusion: The HALP score and PNI proved to be easy and fast cancer screening tests that can predict cancer metastasis in the etiology of patients with pericardial effusion. Background studies immuneinflammation immune inflammation (SII) (PNI) hemoglobin albumin lymphocyte (HALP Objectives Methods 200 2022 28 moderatetolarge moderate large period procedure p005 p 0 05 p<0.05 Results 0173 173 0.17 0.1250.175 01250175 0.125 0.175 125 175 (0.125-0.175 032 32 0.3 0.200.49 020049 0.20 0.49 20 49 (0.20-0.49 noncancer non p<0.001. p0001 p<0.001 . 001 (p<0.001) 33156 33 1 5 6 33.1±5. 39848 39 8 4 39.8±4. Conclusion (SII (PNI 202 2 p00 p<0.0 017 17 0.1 1250 0.1250.17 0125017 0125 0.12 0175 12 (0.125-0.17 03 3 0. 0.200.4 02004 020 0.2 049 0.4 (0.20-0.4 p000 p<0.00 00 (p<0.001 3315 33.1±5 3984 39.8±4 p0 p<0. 01 0.1250.1 012501 012 (0.125-0.1 0.200. 0200 02 04 (0.20-0. (p<0.00 331 33.1± 398 39.8± p<0 0.1250. 01250 (0.125-0. 0.200 (0.20-0 (p<0.0 33.1 39.8 p< 0.1250 (0.125-0 (0.20- (p<0. 33. 39. (0.125- (0.20 (p<0 (0.125 (0.2 (p< (0.12 (0. (p (0.1 (0 (

Resumo Fundamento: A triagem do câncer é absolutamente necessária em pacientes com derrame pericárdico, pois o câncer é uma das doenças mais graves em sua etiologia. Estudos anteriores indicaram que o índice de inflamação imunológica sistêmica (IIS), o índice prognóstico nutricional (PNI) e o escore de hemoglobina, albumina, linfócitos e plaquetas (HALP) podem ser escores relacionados ao câncer. Objetivos: Este estudo foi iniciado considerando que esses sistemas de pontuação poderiam prever o câncer na etiologia de pacientes com derrame pericárdico. Métodos: Os pacientes submetidos à pericardiocentese entre 2006 e 2022 foram analisados retrospectivamente. A pericardiocentese foi realizada em um total de 283 pacientes com derrame pericárdico ou tamponamento cardíaco de moderado a grande no período especificado. Os índices de HALP, PNI e IIS foram calculados do sangue venoso periférico retirado antes do procedimento de pericardiocentese. O nível de significância estatística foi aceito em p<0,05. Resultados: O escore HALP foi de 0,173 (0,125-0,175) em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi de 0,32 (0,20-0,49; p<0,001). O escore de PNI foi de 33,1±5,6 em pacientes com câncer. Detectou-se que em pacientes não oncológicos o escore foi 39,8±4,8 (p<0,001). Conclusão: Os escores HALP e PNI são testes de triagem de câncer fáceis e rápidos que podem prever metástases de câncer na etiologia de pacientes com derrame pericárdico. Fundamento IIS, , (IIS) (PNI hemoglobina albumina (HALP Objetivos Métodos 200 202 retrospectivamente 28 especificado p005 p 0 05 p<0,05 Resultados 0173 173 0,17 0,1250,175 01250175 0,125 0,175 125 175 (0,125-0,175 Detectouse Detectou se 032 32 0,3 0,200,49 020049 0,20 0,49 20 49 (0,20-0,49 p<0,001. p0001 p<0,001 . 001 p<0,001) 33156 33 1 5 6 33,1±5, 39848 39 8 4 39,8±4, (p<0,001) Conclusão (IIS 2 p00 p<0,0 017 17 0,1 1250 0,1250,17 0125017 0125 0,12 0175 12 (0,125-0,17 03 3 0, 0,200,4 02004 020 0,2 049 0,4 (0,20-0,4 p000 p<0,00 00 3315 33,1±5 3984 39,8±4 (p<0,001 p0 p<0, 01 0,1250,1 012501 012 (0,125-0,1 0,200, 0200 02 04 (0,20-0, 331 33,1± 398 39,8± (p<0,00 p<0 0,1250, 01250 (0,125-0, 0,200 (0,20-0 33,1 39,8 (p<0,0 p< 0,1250 (0,125-0 (0,20- 33, 39, (p<0, (0,125- (0,20 (p<0 (0,125 (0,2 (p< (0,12 (0, (p (0,1 (0 (

ABSTRACT Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and tamponading effusion. Surgical options include: pericardiocentesis, subxiphoid pericardiostomy, and pericardial window. The latter has proved to have lower incidence of recurrence; however, the technique has been continuously refined to improve the recurrence-free survival and decrease postoperative morbidity. We herein present a novel simple modification to minimize recurrence by anchoring the free edges of pericardial fenestration overlying the superior vena cava and right atrium to the chest wall. Follow-up showed no recurrence compared to 3.5% in the conventional procedure. disorders include pericardiocentesis pericardiostomy window however recurrencefree morbidity wall Followup Follow up 35 3 5 3.5 procedure 3.

Resumen: Aunque su uso sólo está indicado para el acceso a venas centrales en medicina humana, en el presente reporte describimos la implantación de un dispositivo Port-a-Cath en el espacio pericárdico de una hembra canina de la raza Ovejero Alemán. Esta paciente fue diagnosticada de un hemangiosarcoma en la pared auricular derecha y a consecuencia de la colecta pericárdica padeció signos de taponamiento cardíaco previamente a la implantación del dispositivo. La técnica utilizada supuso una dificultad quirúrgica media y ofreció un acceso percutáneo a la cavidad pericárdica de forma permanente tanto para la aspiración de la colecta como para la administración de Cisplatino, el cual se administró en una sola dosis a los 7 días post implantación. Se realizaron controles semanales de permeabilidad y posicionamiento del dispositivo, sin verificar colecta pericárdica hasta el día 52 de implantado en el que comenzó nuevamente a colectar cantidades que variaban entre 15 y 50 ml de líquido serosanguinolento. Este fue fue aspirado con intervalos de 3 días hasta que el animal fue eutanasiado de forma compasiva en el día 68. El dispositivo Port-a-Cath se mantuvo permeable, no se evidenciaron complicaciones asociadas al mismo, ni migraciones hacia la cavidad pleural. Una vez eutanasiada la paciente, se realizó una toracotomía con el fin de enviar muestras de tejido al laboratorio de histopatología donde se confirmó el diagnóstico de hemangiosarcoma. Al comprobarse la existencia de múltiples metástasis en pulmones, resto del corazón, pericardio y tejido subcutáneo y a través de la sintomatología asociada a disnea en reposo, se pudo concluir que la paciente no falleció por taponamiento cardíaco, sino por el tumor y sus agregados metastásicos. El implante de un dispositvo Port-a-Cath mostró ser una alternativa para la prevención del taponamiento cardíaco de origen maligno en esta paciente canina.

Abstract: Although its use is only indicated for access to central veins in human medicine, we describe the implantation of a Port-a-Cath device in the pericardial space of a female German Sheperd dog. This patient was diagnosed with a hemangiosarcoma in the right atrial wall and as a result of the pericardial effusion the dog suffered signs of cardiac tamponade prior to the implantation of the device. The technique supposed a medium surgical difficulty and offered percutaneous access to the pericardial cavity permanently both for the aspiration of the effusion and for the administration of Cisplatin, which was administered in a single dose 7 days after implantation. Weekly controls of permeability and positioning of the device were carried out, without verifying pericardial effusion until day 52 after implantation, in which the patient began to collect amounts of fluid with a range of 15 to 50 ml. This was aspirated with intervals of 3 to 5 days until the animal was compassionately euthanized on day 68. The Port-a-Cath device remained permeable, there were no complications associated with it, nor migrations into the pleural cavity. Once the patient was euthanized, a thoracotomy was performed in order to have the final histopathology diagnosis in which hemangiosarcoma was confirmed. The existence of multiple metastasis in the lungs, rest of the heart, pericardium and subcutaneous tissue, and the symptoms associated with dyspnea at rest, helped to conclud that the patient did not die from cardiac tamponade, but from the tumor and its metastasis. The implantation of a Port-a-Cath device proved to be an alternative for the prevention of malignant cardiac tamponade in this canine patient.

Resumo: Embora seu uso seja indicado apenas para acesso às veias centrais na medicina humana, no presente relato descrevemos o implante de dispositivo Port-a-Cath ou cateter totalmente implantado no espaço pericárdico de um canino da raça Pastor Alemão. O paciente foi diagnosticado com hemangiossarcoma em parede de átrio direito e, em decorrência da efusão pericárdica, apresentou sinais de tamponamento cardíaco prévios ao implante do dispositivo. A técnica utilizada foi de média dificuldade cirúrgica e proporcionou acesso percutâneo permanente à cavidade pericárdica tanto para aspiração da efusão pericárdica quanto para administração de cisplatina, que foi administrada em dose única 7 dias após o implante. Foram realizadas provas semanais de permeabilidade e posicionamento do dispositivo, sem produção de efusão pericárdica até o dia 52 após o implante, quando voltou a produzir quantidades que variaram entre 15 e 50 ml de líquido serosanguinolento. Tal efusão foi aspirada em intervalos de 3 a 5 dias até que o animal fosse eutanasiado no dia 68. O dispositivo Port-a-Cath permaneceu funcional, não havendo complicações nem migrações para a cavidade pleural. Após a eutanásia do paciente, foi realizada toracotomia para envio de amostras ao laboratório de histopatologia, onde foi confirmado o diagnóstico de hemangiossarcoma. Concluimos que a causa do quadro clínico de dispneia em repouso, incompatível com a vida, foi a existência de múltiplas metástases nos pulmões, coração, pericárdio e tecido subcutâneo pelo quadro avançado do hemangiossarcoma, descartando tamponamento cardíaco como causa da morte. O implante do dispositivo Port-a-Cath mostrou-se uma alternativa para a prevenção do tamponamento cardíaco de origem maligna neste paciente canino.

Abstract Introduction: There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade. Methods: We retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared. Results: Sixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044). Conclusion: Apical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment. Introduction However Methods 201 2019 groups profiles findings Results Sixtyeight Sixty eight period 2 4 48.1% 481 48 1 (48.1 vs 49 9 4.9% P<0.001. P0001 P P<0.001 . 0 001 P<0.001) 36.6% 366 36 6 (36.6 111 11 11.1% P=0.02, P002 P=0.02 , 02 P=0.02) 12.2% 122 12 (12.2 407 40 7 40.7% P=0.007. P0007 P=0.007 007 P=0.007) 77.8% 778 77 8 (77.8 537 53 53.7% P=0.044. P0044 P=0.044 044 P=0.044) Conclusion treatment 20 48.1 (48. 4.9 P000 P<0.00 00 36.6 3 (36. 11.1 P00 P=0.0 12.2 (12. 40.7 P=0.00 77.8 (77. 5 53.7 P004 P=0.04 04 48. (48 4. P<0.0 36. (36 11. P0 P=0. 12. (12 40. 77. (77 53. (4 P<0. (3 P=0 (1 (7 ( P<0 P= P<

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

RESUMO Objetivo: Descrever e discutir um raro caso de tamponamento cardíaco na presença de Lúpus Eritematoso Sistêmico (LES) e infecção por Citomegalovírus (CMV) em um paciente pediátrico, as associações entre estas duas entidades, a abordagem diagnóstica e os possíveis tratamentos neste cenário. Descrição do caso: Paciente com nove anos de idade, sexo feminino, foi admitida no departamento de emergência com dispneia grave, hipofonese de bulhas, turgência jugular, instabilidade hemodinâmica e palidez intensa. Estava em acompanhamento ambulatorial prévio por quadro de dispneia leve, poliartrite, febre e manifestações cutâneas variadas há seis meses. Ecodopplercardiograma revelou efusão pericárdica. A paciente foi submetida à pericardiocentese seguida por drenagem pleuropericárdica em selo d’água, sem intercorrências. A investigação prosseguiu com o preenchimento de critérios clínico-laboratoriais para LES e a presença de antigenemia para CMV de 15/200.000 células. Foram iniciadas medicações para controle do LES e do CMV, com boa resposta clínico-laboratorial. Comentários: O LES pediátrico manifesta-se comumente de maneira mais grave, gerando alta morbimortalidade. Tamponamento cardíaco pode ser uma das primeiras manifestações do LES, que pode também ser precipitada por agentes infecciosos, como o CMV, levando à confusão diagnóstica e retardando o correto tratamento do paciente. Mudanças na terapêutica apropriada também devem ser consideradas na presença de ambas as condições. Com base nisso, apresentamos um caso de LES juvenil agravado por infecção por CMV e a manifestação pouco usual de tamponamento cardíaco.%

ABSTRACT Objective: To describe a rare case of cardiac tamponade in a pediatric patient with systemic lupus erythematosus (SLE) and cytomegalovirus (CMV) infection, and to discuss the relationship between these morbidities, the diagnostic approach, and the possible treatments. Case description: A 9-year-old girl presented to the emergency department with severe dyspnea, muffled heart sounds, jugular vein distention, hemodynamic instability, and intense pallor. She had previously been followed up at the outpatient clinic for a six-month history of mild respiratory distress, polyarthritis, fever, and various cutaneous manifestations. Doppler echocardiogram revealed pericardial effusion. The patient was submitted to pericardiocentesis followed by water seal pleuropericardial drainage, with no complications. The investigation continued, with fulfillment of clinical and laboratory SLE criteria plus CMV antigenemia of 15/200,000 cells. Medications to control CMV infection and SLE were then initiated, with good clinical and laboratory response. Comments: Pediatric SLE commonly manifests in a more severe form, accounting for high morbimortality. Cardiac tamponade could be one of the first manifestations of SLE, which can also be precipitated by infectious agents, such as CMV, leading to diagnostic confusion and misleading the treatment. Changes in therapeutics must also be considered in the presence of both conditions. This study presents a juvenile SLE case aggravated by a CMV infection with the unusual manifestation of cardiac tamponade.%

Resumen El derrame pericárdico (DP) es una entidad frecuente en la práctica diaria, que puede ocurrir por un amplio rango de patologías. Los métodos por imágenes constituyen una herramienta diagnóstica clave en la evaluación del pericardio. El ecocardiograma transtorácico (ETT) se considera de primera línea por su costo-efectividad. La tomografía computarizada multicorte (TCMC), por su parte, representa un valioso complemento ante limitaciones del ETT y en la evaluación de urgencia del paciente con sospecha de DP. El objetivo del trabajo es mostrar la utilidad y rol de la TCMC, mediante la medición de densidades, para estimar la etiología del DP, ilustrado con casos de nuestra institución.

Abstract Pericardial effusion (PE) is a common entity in daily practice, which can occur due to a wide range of conditions. Imaging methods are a key diagnostic tool in the evaluation of the pericardium. Transthoracic echocardiogram (TTE) is the first line imaging method because of its cost-effectiveness. Multi-slice Computed Tomography (MSCT), on the other hand, represents a valuable complement to the limitations of TTE and in emergency evaluation of the patient with suspected PE. The objective of this review is to show the usefulness and role of the MSCT —through the measurement of densities— to estimate the etiology of PE, illustrated with cases of our Institution.

ABSTRACT Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and tamponading effusion. Surgical options include: pericardiocentesis, subxiphoid pericardiostomy, and pericardial window. The latter has proved to have lower incidence of recurrence; however, the technique has been continuously refined to improve the recurrence-free survival and decrease postoperative morbidity. We herein present a novel simple modification to minimize recurrence by anchoring the free edges of pericardial fenestration overlying the superior vena cava and right atrium to the chest wall. Follow-up showed no recurrence compared to 3.5% in the conventional procedure.

Abstract: Dobutamine stress echocardiography is widely used in stratification after an acute myocardial infarction. Complications that can be life threatening have been reported, ventricular arrhythmias being the most frequent. Cardiac rupture is a rare but fatal complication. We report the case of a 68-year-old male with an inferior infarction without a reperfusion strategy, who underwent a dobutamine stress echocardiogram 6 days after the infarction. During the initial recovery, the patient presented cardiac rupture due to the presence of a pericardial effusion with a hematic appearance and electro-mechanical dissociation. Emergency pericardiocentesis was performed, eventually the patient died. Recent inferior infarction and a dyskinetic zone have been reported in the literature as high-risk characteristics to present. Proper selection of the patient, a baseline echocardiogram without risk characteristics for rupture, and the time to perform the study after the infarction can reduce the incidence of this complication.

Resumen: El ecocardiograma de estrés con dobutamina es ampliamente utilizado en la estratificación posterior a un infarto agudo al miocardio. Se han reportado complicaciones que pueden ser potencialmente mortales, siendo las arritmias ventriculares las más frecuentes. La ruptura cardiaca es una complicación rara, pero fatal. Se presenta el caso de un masculino de 68 años con un infarto inferior sin estrategia de reperfusión, el cual fue sometido a un ecocardiograma de estrés con dobutamina a los seis días del infarto. Durante la recuperación inicial el paciente presenta ruptura cardiaca por presencia de derrame pericárdico de aspecto hemático y disociación electro mecánica. Se realizó pericardiocentesis de urgencia, finalmente falleciendo el paciente. En la literatura se ha reportado el infarto inferior reciente y una zona discinética como las características de alto riesgo para presentarse. La selección adecuada del paciente, un ecocardiograma basal sin características de riesgo para ruptura y el tiempo de realización del estudio posterior al infarto puede disminuir la incidencia de esta complicación.

Resumo Introdução: A pericardiocentese é uma técnica valiosa no diagnóstico e tratamento de doentes com derrame pericárdico, já tendo sido testados vários métodos para reduzir complicações e aumentar a taxa de sucesso deste procedimento. O objectivo deste estudo foi avaliar o sucesso do procedimento, utilização de ecocardiograma, taxa de complicações e utilidade para o estudo etiológico de doentes com derrame pericárdico. Material e Métodos: Análise retrospectiva de 55 pericardiocenteses realizadas em 48 doentes entre Janeiro de 2013 e Dezembro de 2019 numa Unidade de Cuidados Intensivos de um hospital periférico. Resultados e Discussão: O procedimento foi assistido por ecocardiograma em 64% dos casos, tendo sido verificada uma taxa de sucesso de 100%, de complicações de 9,1% e de recorrência de 12,7%. Verificou-se maior número de punções necessárias para o sucesso, maior taxa de complicações e maior gravidade destas quando a pericardiocentese não foi guiada por ecocardiograma, o que explica outcomes piores face a outras séries realizadas sempre com apoio eco-cardiográfico. A análise citoquímica do líquido pericárdico não permitiu extrapolar os critérios de Light do derrame pleural, no entanto verificou-se uma tendência para associação entre casos clássicos de exsudado (neoplasia e infecção) e LDH elevado no líquido pericárdico; ADA>50 U/L foi muito específico para derrame pericárdico de origem tuberculosa. A etiologia mais comum foi neoplásica (33%, n = 16), com uma sobrevida média de 5,7 meses nestes doentes, comparando com 21,6 meses nas outras causas. Conclusão: A pericardiocentese guiada por ecocardiograma teve uma elevada taxa de sucesso associada a menor percentagem de complicações, pelo que se defende a sua utilização em todos os procedimentos. Esta técnica tem um principal objectivo terapêutico nos derrames moderados a graves, visto que não foi possível obter critérios suficientemente úteis para estabelecer um diagnóstico etiológico.

Abstract Introduction: Pericardiocentesis is a valuable technique to diagnose and treat patients with pericardial effusion, and several methods have already been tested to reduce complication and increase success rates of this procedure. The aim of this study was to evaluate procedure success, use of echocardiogram, complications rate and usefulness for etiologic study of patients with pericardial effusion. Material and Methods: Retrospective analysis of 55 pe-ricardiocentesesis performed on 48 patients between Ja-nuary 2013 and December 2019 in an Intensive Care Unit from a peripheral hospital. Results and Discussion: It was assisted by echocardio-graphy in 64% of cases, with a 100% success rate, 9.1% complications rate, and 12.7% recurrence rate. There was a greater number of punctures necessary for success, a higher rate of complications and greater severity of them when pericardiocenteses was not guided by echocardiography, which explains worse outcomes when compared to other series where echocardiography was used in every single procedure. Pericardial fluid analysis did not allow extrapolating Light criteria for pleural effusion, however there was a tendency for an association between classic exudate cases (neoplasia and infection) and higher LDH in pericardial fluid; ADA>50 U/L was very specific for tuberculous pericardial effusion. Most common etiology was neoplastic (33%, n = 16), with an average survival of 5.7 months in these patients, compared with 21.6 months in other causes. Conclusion: Echocardiogram-guided pericardiocente-ses had a high success rate associated with a lower percentage of complications, which is why its use in all procedures is advocated. This technique has a main therapeutic goal in moderate to severe effusions, since it was not possible to obtain useful criteria to establish an etiological diagnosis.

El taponamiento cardiaco es la acumulación de líquido dentro del saco pericárdico, lo que conlleva a un aumento de la presión intrapericardica, permitiendo el deterioro de la capacidad del corazón para llenarse y actuar como bomba. Entre sus causas tenemos a la tuberculosis, las colagenopatías, y el cáncer. En el embarazo se pueden enmascarar los signos y síntomas del taponamiento cardiaco por los cambios fisiológicos propios del embarazo. El Gold estándar para su detección es la ecocardiografía. El tratamiento del taponamiento cardiaco es la pericardiocentesis o el drenaje quirúrgico. Se presenta el caso de una paciente de 26 años con: embarazo de 32,6 semanas, trabajo de parto pretérmino, taponamiento cardiaco y post pericardiocentesis de 2 horas, para culminación de embarazo. El manejo anestésico es complejo tanto para la madre y el recién nacido, basándose en mantener estabilidad hemodinámica y posterior traslado a unidad de terapia intensiva.

Cardiac tamponade is the accumulation of fluid within the pericardial sac, which leads to an increase in intrapericardial pressure, allowing the deterioration of the heart’s ability to fill and act as a pump. Among its causes are tuberculosis, collagen disease, and cancer. In pregnancy, the signs and symptoms of cardiac tamponade can be masked by the physiological changes of pregnancy. The gold standard of detection is echocardiography. Treatment of cardiac tamponade is pericardiocentesis or surgical. The case of a 26-year-old patient is presented with: a 32.6 for week pregnancy in preterm labor, cardiac tamponade and 2-hour post-pericardiocentesis, for culminate of pregnancy. Anesthetic management is complex for both the mother and the newborn, basing on maintaining hemodynamic stability and subsequent transfer to the intensive care unit.

ABSTRACT The chyle is the term used to refer to lymphatic fluid of intestinal origin. It consists of lymph and emulsified fats; it circulates through the lymphatic vessels and passes into the venous system through the thoracic duct. The chylothorax is the accumulation of chyle in the pleural space, caused by any pathological process that increases the systemic venous pressure, such as trauma, mediastinal tumors, heart disease or congenital abnormalities of the thoracic duct. In most cases, the specific cause cannot be ascertained and it is called idiopathic chylothorax. The objective of this paper was to present a clinical case of an American Pitbull Terrier canine patient with idiopathic chylothorax. The dog was referred with restrictive dyspnea and mucous cyanosis. Chest ultrasound showed pleural and pericardial effusion, therefore, pericardiocentesis and thoracocentesis were performed, from which 370 mL of pericardial effusion and 600 mL of pleural effusion were extracted. The dog underwent surgery within 48 hours. The technique consisted of combining a pericardiectomy with an omentalization in order to avoid cardiac tamponade and ensure physiological drainage of the pleural space, increasing the reabsorption of the chyle. It was only necessary to change the chest tube after 48 hours. The dog regained its normal weight during the first month. He is currently ten months old and has no clinical evidence of recurrence.

RESUMEN El quilo es el término con que se denomina al líquido linfático de origen intestinal. Está constituido por linfa y grasas emulsionadas, circula por los vasos linfáticos y pasa al sistema venoso a través del conducto torácico. El quilotórax es la acumulación de quilo en el espacio pleural, es provocado por cualquier proceso patológico que aumente la presión venosa sistémica, traumatismo, tumores en el mediastino, cardiopatía o anomalías congénitas del conducto torácico. En la mayoría de los casos no se puede llegar a conocer la causa específica y se denomina quilotórax idiopático. El presente trabajo tiene como objetivo la presentación de un caso clínico de un canino de raza American Pitbull Terrier con quilotórax idiopático, el cual fue remitido a consulta con disnea restrictiva y cianosis de las mucosas. La ecografía de tórax mostraba efusión pleural y pericárdica, por lo que se realizó pericardiocentesis y toracocentesis, de la cual se extrajo 370 mL de efusión pericárdica y 600 mL de efusión pleural. Se sometió al paciente a una intervención quirúrgica a las 48 horas. La pericardiectomía y la omentalización se combinaron con el objetivo de evitar taponamiento cardíaco y garantizar un drenaje fisiológico del espacio pleural aumentando la reabsorción del quilo. El presente caso se resolvió definitivamente a los cuatro días de la intervención; solo fue necesario cambiar el tubo torácico a las 48 horas. El paciente recuperó su peso normal durante el primer mes; actualmente lleva diez meses de operado sin evidencias clínicas de recidiva.