Heart glows when a Cook needle enters the pericardium

A moderate pericardial effusion causes tamponade in the acute setting. The bloody tap confuses the operator as to whether or not the tip of an 18-gauge Cook needle is in the pericardial cavity before introducing the sheath and pigtail catheter, unless the short J-tipped guidewire follows the pericardial wall (Video 1). The agitated saline contrast support under echo guidance, iodinated contrast injection under fluoroscopy, or both, are of great help (Video 2). The blood and contrast mixture occupies the whole pericardial cavity because of tachycardia and tachypnoea. The radiolucent heart looks like lighted bulb. Iatrogenic pneumopericardium is a close differential diagnosis. In this case, a 12-year-old girl developed tamponade due to the acute rupture of a large mediastinal dermoid cyst. Immediate pericardiocentesis was performed under fluoroscopic guidance, and 350 mL of serosanguinous collection was aspirated. We noticed that the radiolucent heart looked like a lighted bulb; “heart glows when a Cook needle enters the pericardium” is an amusing sign. (Video 3).