Right ventricular perforation as a complication of fluoroscopy-guided pericardiocentesis.

A 77-year-old woman presented to our emergency department with worsening shortness of breath. She was hemodynamically stable. Initial work-up was significant for hemoglobin 10.3 g/dl and enlarged cardiac silhouette on the chest X-ray. Transthoracic echocardiography showed a large circumferential pericardial effusion and dilated inferior vena cava. There was no right chamber collapse. Therapeutic pericardiocentesis was performed in the cardiac catheterization laboratory. An attempt was made to drain the pericardial fluid through a subxiphoid window under fluoroscopic guidance using a percutaneous needle. About 200 ml of serosanguinous fluid was aspirated. A guide wire was then advanced through the needle hub, the needle was removed and a pigtail catheter was introduced and left in place through a catheter-over-wire technique for further drainage. The procedure was considered successful by the performing cardiologist and the patient was admitted. No further drainage was noticed during the next 12 hours. The