Hello all! This week’s VOTW is brought to you by myself!
Hospital course
50 y/o F with PMH ESRD on HD, HTN, presented to the ED after a syncopal episode. The patient was intubated for respiratory failure but afterwards developed worsening hypotension and tachycardia. Bedside transthoracic echocardiogram was performed.
Ultrasound
In this parasternal long view of the heart, we can see an effusion within the pericardial sac (pericardial effusion). This is represented by anechoic fluid that tracks anterior to the descending aorta. However, note that there is also fluid POSTERIOR to the descending aorta – this is a pleural effusion!
In this apical-4 chamber view of the heart, again we can see a pericardial effusion. Note that the right atrial wall collapses during systole!
Case Conclusion
The echocardiogram confirmed the presence of a large pericardial effusion with signs of early tamponade as well as a pleural effusion. The patient was admitted to the MICU.
Cardiac tamponade, pericardial effusions, and pleural effusions
· It is important to be able to differentiate a pericardial effusion and a pleural effusion on the parasternal long view of the heart. Both look similar however there is one key differentiating factor. A pericardial effusion will be located ANTERIOR to the descending aorta, while a pleural effusion will be located POSTERIOR to the descending aorta.
· The earliest sonographic finding of cardiac tamponade is right atrial collapse during early systole. As the pericardial effusion continues to grow, diastolic right ventricular collapse can also occur.
Happy scanning!
Sono team
Resources to review:
· https://www.acep.org/emultrasound/newsroom/may-2024/cardiac-tamponade
· https://www.emdocs.net/us-probe-when-does-an-effusion-become-pericardial-tamponade/