IOTW: Pericardial effusion

Posted on: September 17, 2019, by :

The image of the week is impressive. This teen had undifferentiated cardiomegaly on a chest Xray from an outside institution. POCUS was requested by the astute providers. You see 2 identical cardiac images of the parasteral long view (PSL) of the heart (one original, and the other annotated). From images of prenatal ultrasounds, even the layperson knows that black on ultrasound is fluid.There is a large black space surrounding the heart= Pericardial Effusion (931cc in this case).

How does one distinguish pericardial effusion from pleural effusion?

Pericardial effusion is above the descending aorta and often crosses the midline above the aorta. Pleural effusion is seen below/posterior to the descending aorta and does not cross the midline.

image-20
https://www.saem.org/cdem/education/online-education/m3-curriculum/bedside-ultrasonagraphy/pericardial-effusion

We’re taught that tamponade physiology is a clinical diagnosis (with only small % exhibiting Beck’s Triad of JVD, muffled heart sounds and hypotension), but FOCUS (focused cardiac ultrasound) is a good adjunct to evaluate RV collapse during diastole. In this image, you see the mitral valve fully open during diastole, and RV is relatively intact. The workup is still underway for the patient for the final diagnosis.

“The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.”

https://www.saem.org/cdem/education/online-education/m3-curriculum/bedside-ultrasonagraphy/pericardial-effusion
https://cdemcurriculum.files.wordpress.com/2017/02/image-20.png

Rosemary Thomas-Mohtat MD

Pediatric Emergency Medicine Attending at Children's National Health System
Rosemary has lived an adventurous life both geographically and professionally. She grew up an army brat in India living in 5 cities in her ten years there, then schooling in the many boroughs of NYC.Her professional journey has involved residency and a year of private practice in Pittsburgh, followed by a fellowship in Pediatric Nephrology at Montefiore and a year of bench genetics research at Columbia University, all the while working in a Peds ER in the Bronx. It was there that she found her true calling! She graduated PEM Fellowship at Children's National Medical Center, and then completed a one year Point of Care Ultrasound (POCUS) Fellowship. In her spare time, she loves running around Bethesda and the world with her family, including 2 sweet kiddos.
Rosemary Thomas-Mohtat MD

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