During pericardiocentesis (needle aspiration of pericardial effusion), the needle is inserted at the left xiphicostal angle (between xiphoid and left costal margin) and directed at 45° toward the left shoulder. Which layer is entered last before reaching the pericardial cavity?

• A Pleura
• B Epicardium (visceral pericardium)
• C Fibrous pericardium ✓
• D Myocardium

Explanation

Layers traversed during pericardiocentesis at the xiphicostal angle (subxiphoid approach): skin → subcutaneous fat → anterior rectus sheath → rectus abdominis → posterior rectus sheath → extraperitoneal fat → diaphragm → fibrous pericardium → parietal layer of serous pericardium → pericardial cavity. The fibrous pericardium (tough outer layer) is the last layer before entering the pericardial space. The visceral pericardium (epicardium) overlies the heart muscle and is on the other side of the pericardial cavity.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.