Pericardial Effusion and Tamponade
Pericardial effusion is a relatively common finding in high-risk patients evaluated in the emergency department . It should be considered in differential diagnosis for patients with different clinical presentations such as shortness of breath, chest pain, and hypotension . Physical examination alone may not be very accurate in identifying patients with cardiac tamponade and point-of-care ultrasound has been shown to be a very useful clinical tool . Pericardial effusion is easily identified by ultrasound examination. Hemodynamic significance of the effusion can be assessed by a set of additional findings such as chamber collapse, flow variation across the atrioventricular valves, and inferior vena cava engorgement. These require good understanding of tamponade physiology, training in spectral Doppler and M-mode echocardiography, and advanced examination skills.
KeywordsPoint-of-care cardiac ultrasound Pericardial effusion Tamponade Pleural effusion Inferior vena cava
All images courtesy of Dr. Edgar Argulian.
Pericardial effusion in the subcostal view. In this view, the right ventricle (RV) and right atrium (RA) are closer to the transducer, while the left ventricle (LV) and left atrium (LA) are in the far field. Pericardial effusion (Pef) appears as an echo free space around the heart, both along the diaphragm above the liver (Lr) and along the lateral wall of the left ventricle. See also Fig. 18.2 (AVI 9574 kb)
Ascites and right pleural effusion in the subcostal view. This patient with biventricular dysfunction has anasarca. Ascites (Asc) is seen as an echo free space below the diaphragm; one can also identify the falciform ligament (FL). Right pleural effusion (Pl) is seen as an echo free space above the diaphragm. The highly echogenic implantable defibrillator lead is seen in the right ventricle. See also Fig. 18.4 (AVI 17972 kb)
Pericardial fat in the parasternal long axis view. Pericardial fat commonly appears as hypoechoic area overlying the right ventricular outflow tract (RVOT) in the parasternal long axis view. It should not be confused with pericardial effusion. The thin and bright line of the parietal pericardium is seen (arrow) separating the anterior pericardial fat from posterior epicardial fat. See also Fig. 18.5 (AVI 13883 kb)