From May 1999 to January 2002, three transbronchial pericardiocenteses were performed in our Department of Internal Medicine. Every bronchoscopy was preceded by sedation with midazolam and phentanyl and local mucosal anesthesia with mepivacain 1%, and accomplished with a Wang endoscopic needle (MW-122; Mill Rose Labs; Mentor, OH), through the 2.8-mm channel of a flexible fiberoptic bronchoscope (Olympus TE; Olympus Europe; Hamburg, Germany). After an accurate evaluation of CT scanning, bronchoscopy was performed under conscious sedation. The airways were rapidly explored to exclude any visible abnormality. The catheter containing the endoscopic needle was then introduced into the scope channel, and the needle was completely inserted through the anterior wall of the left lower lobe bronchus (Fig 2
), when the purpose was the evacuation of a posterior pericardial effusion, or through the tracheal wall (second intercartilage space of the distal trachea at 12 o’clock; Fig 3
), in order to reach the aortic recess of the pericardium. The puncture was performed without any radiologic or sonographic guide according to the “pushing technique” described by Wang18
: the needle tip is first lodged in the mucosa of the puncture site, after which the catheter is further advanced, so that the entire length of the needle protrudes out of the tip of the bronchoscope; the operator then fixes the proximal end of the catheter to the bronchoscope with one or two fingers, and pushes the bronchoscope and the catheter into the bronchial wall as one unit. Suction was then applied by a 20-mL syringe connected to the proximal end of the endoscopic needle, and the fluid collected was flushed into a sterile jar.