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Thread: Minimal Pericardial Effusion - Ultrasound Atlas

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    Default Minimal Pericardial Effusion - Ultrasound Atlas

    Pericardial effusion, sometimes referred to as "fluid around the heart," is the abnormal build-up of excess fluid that develops between the pericardium, the lining of the heart, and the heart itself.

    Causes pericardial effusion:
    Pericardial effusion, and the possible inflammation of the pericardium resulting from it (called pericarditis), can have many possible causes, including:

    • Infection such as viral, bacterial or tuberculous
    • Inflammatory disorders, such as lupus
    • Cancer that has spread (metastasized) to the pericardium
    • Kidney failure with excessive blood levels of nitrogen
    • Heart surgery

    Who is affected by pericardial effusions?
    Since pericardial effusions are a result of many different diseases or conditions, anyone who develops one of the many conditions that can produce an effusion may be affected.

    Is pericardial effusion serious?
    The seriousness of the condition depends on the primary cause and size of the effusion and whether it can be treated effectively. Causes that can be treated or controlled, such as an infection due to a virus or heart failure, allows the patient to be effectively treated and remain free of pericardial effusions.
    Pericardial effusion caused by other conditions, such as cancer, is very serious and should be diagnosed and treated promptly.
    Additionally, rapid fluid accumulation in the pericardium can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. Cardiac tamponade resulting from pericardial effusion can be life-threatening.

    Minimal Pericardial Effusion Ultrasound Atlas attachment.php?attachmentid=439&stc=1&d=1436802650
    Symptoms of pericardial effusion:
    Many patients with pericardial effusion have no symptoms. The condition is often discovered on a chest x-ray or echocardiogram that was performed for another reason. Initially, the pericardium may stretch to accommodate excess fluid build-up. Therefore, signs and symptoms may not occur until a large amount of fluid has collected over time.
    If symptoms do occur, they may result from compression of surrounding structures, such as the lung, stomach or phrenic nerve (a nerve that connects to the diaphragm). Symptoms also may occur due to diastolic heart failure (heart failure that occurs because the heart is unable to relax normally between each contraction due to the added compression).
    Symptoms of pericardial effusion include:

    • Chest pressure or pain
    • Shortness of breath
    • Nausea
    • Abdominal fullness
    • Difficulty in swallowing

    Symptoms that pericardial effusion is causing cardiac tamponade include:

    • Blue tinge to the lips and skin
    • Shock
    • Change in mental status

    Cardiac tamponade is a severe compression of the heart that impairs its ability to function. Cardiac tamponade resulting from pericardial effusion can be life-threatening and is a medical emergency, requiring urgent drainage of the fluid.

    Pericardial effusion diagnosis:
    The tests most commonly used to diagnose and evaluate pericardial effusion include:

    • Chest x-ray:
    • a very small pericardial effusion can be occult on plain film
    • there can be globular enlargement of the cardiac shadow giving a water bottle configuration
    • lateral CXR may show a vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly from a similar lucent vertical lucent line (pericardial fat) posteriorly; this is known as the Oreo cookie sign
    • widening of the subcarinal angle without other evidence of left atrial enlargement may be an indirect clue
    • a differential density sign at cardiac borders has been suggested 9, but its specificity is limited
    • Computed tomography (CT) scan of the chest:The generally accepted thickness of a normal pericardium, measured on CT scans and on MR images is often taken at 2 mm.CT makes the diagnosis extremely easy, but is usually obtained to try and clarify the cause of an effusion rather than to confirm the diagnosis. Pericardial effusions are a frequent incidental finding in unwell hospitalised patients.
      Fluid density material is seen surrounding the heart. Careful inspection of the region is necessary to ensure that no invasive mass can be identified.
    • Echocardiogram:Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the haemodynamicimpact of the effusion.
    • Pericardiocentesis: a procedure that uses a needle to remove fluid from the pericardium; the fluid is then examined to determine the cause of the effusion


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