2026 FSA Podium and Poster Abstracts

Introduction: Pericardiocentesis with drain placement is a widely used procedure for the diagnosis and management of symptomatic pericardial effusion and cardiac tamponade. Over 10,000 pericardiocentesis are performed each year. Although imaging guidance (e.g., echocardiography, ultrasound) has significantly improved procedural safety, overall complications remain approximately 1-8%, with major complications such as cardiac perforation, arrythmias, vascular injury, and injury to adjacent organs reported in the literature. Rare but serious complications include hepatic injury during subxiphoid access, diaphragmatic perforation, and pneumothorax. Awareness for these complications is essential for perioperative planning and anesthetic management, particularly in patients with malignancy or risk factors for recurrent effusions. We present a rare case of intrahepatic pericardial drain malposition initially suspected to represent intracardiac placement.

Methods: A 74-year-old male with metastatic lung cancer and a history of a prior pericardiocentesis 1 year ago presented to the University of Miami UHealth tower with dyspnea on exertion. Workup included transthoracic echocardiography which demonstrated a recurrent large pericardial effusion. The patient was scheduled for and underwent subxiphoid pericardial drain placement under echocardiographic guidance in the cardiac catheterization laboratory. During insertion, brisk blood return raised concern for intracardiac perforation. The patient was referred to admitting facility for emergent sternotomy and cardiac puncture site repair.

Results: Median sternotomy was performed; however, no drain was identified within the pericardial space. Further exploration revealed the catheter had been advanced directly into the left hepatic lobe without traversing the diaphragm. General surgery was consulted intraoperatively. The drain was removed, and the hepatic injury was repaired with electrocautery. The patient remained hemodynamically stable throughout the procedure.

Discussion/Conclusion: During pericardiocentesis and drain placement, vigilance for potential complications and readiness for surgical intervention are essential. This case underscores the importance of multimodal imaging to confirm appropriate catheter positioning. Early multidisciplinary collaboration facilitates timely and appropriate management. Careful attention to anatomic relationships and needle trajectory remains critical to minimizing procedural misadventures.