Purulent pericarditis is a life-threatening disease associated with a variety of microorganisms. The case presented herein has unusual manifestations of contrast echoes on two-dimensional echocardiography. To our knowledge, this is the first reported case of pericarditis caused by gas-forming group D Streptococcus and Klebsiella pneumoniae with pyopericardium, resulting in contrast echoes on the two-dimensional echocardiographic image.

Echocardiography↗

PubMedDate not supplied

Intracardiac two-dimensional echocardiography in patients with pericardial effusion and cardiac tamponade.

The utility of intracardiac two-dimensional echocardiography in the identification of pericardial effusion was assessed in five patients with pericardial effusion and cardiac tamponade. A 20 MHz, mechanically rotating ultrasound catheter was used for intracardiac imaging. In all five patients, intracardiac echocardiography yielded high resolution of images of the right atrial cavity, the right atrial wall, and the pericardial effusion. In two patients, right atrial collapse could be identified during real-time imaging. Although the entire right atrial cavity and the pericardial effusion could not be displayed in a single imaging field because of the limited depth of field associated with the 20 MHz catheter, manipulation of the catheter allowed visualization of the pericardial effusion and the parietal pericardium in each patient. The effusion was seen to surround the superior vena cava, as well, in all patients. After pericardiocentesis, the reduction in the size of the effusion and increase in the right atrial cavity size could be recognized by intracardiac echocardiography. The introduction and manipulation of the ultrasound catheter was easily performed without any complications. This experience presents one clinical application for intracardiac echocardiography and indicates its potential value in the invasive cardiac laboratory.

Cardiac Catheterization↗

PubMedDate not supplied

Intracardiac echocardiographic imaging of cardiac abnormalities, ischemic myocardial dysfunction, and myocardial perfusion: studies with a 10 MHz ultrasound catheter.

Intracardiac echocardiography (ICE), an echocardiographic examination from within the heart itself, has been proposed as a new modality for cardiac imaging. A major shortcoming has been the limited depth of field provided by previously available devices. We used 10 MHz catheters for ICE to determine if this lower frequency would allow for greater display of cardiac anatomy. We performed ICE in seven animals; myocardial ischemia was induced in three. With the imaging catheter in the right atrium, all four cardiac chambers and valves could be imaged. Advancing the transducer into the right ventricle allowed for short-axis images of the left ventricle. Coronary perfusion territories and segmental wall motion abnormalities could be observed. We then performed ICE in six patients by advancing the catheter into the right side of the heart percutaneously. Structures of the right side of the heart, the mitral valve, aortic valve, left atrium, and portions of the left ventricle, were visualized. Congenital and acquired abnormalities could be identified. There were no complications. We conclude that ICE with 10F, 10 MHz ultrasound catheters allows for expanded imaging capabilities because of the increased depth of field. With this imaging modality, congenital and acquired abnormalities as well as myocardial ischemia can be detected.

Adult↗

PubMedDate not supplied

The importance of pulsatile microcirculation in relation to hypertension.

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Algorithms↗