A New Window of Opportunity in Echocardiography

Background: Improvements in echocardiographic technology have made technically difficult studies a rare entity. However, physical barriers such as bandages, inability for patients to turn because of intubation, arterial lines, and organ and life support machines make echocardiographic imaging challenging. Methods: We performed echocardiographic imaging from left and right posterior thoracic approach using acoustic properties of pleural fluid to assist in obtaining good imaging windows in patients who had pleural effusion (PE). In this study we describe one author's (T. Z. N.) experience with the mid to lower posterior thoracic window in 18 patients who had PE and in whom conventional transthoracic windows either provided suboptimal images or incomplete clinical information. Results: The posterior approach allowed excellent differentiation of pericardial effusion versus PE, detection of pericardial disease and pericardial infiltration, and excellent endocardial border definition of left and right ventricle in those with poor anterior transthoracic windows. Native and prosthetic aortic valve gradients could be assessed adequately as a result of perfectly parallel Doppler alignment beam to left ventricular outflow tract and aortic valve. In addition, right posterior thoracic window provided views comparable with subcostal view and allowed visualization of inferior vena cava, right atrium, and liver. Conclusion: In patients with PE, imaging from low to midposterior thorax can provide additional diagnostic echocardiographic images and should be used in patients in whom conventional images are technically difficult or require additional information.