Imaging

Pericardial Effusion

Preliminary Diagnosis: Pericardial Effusion

I. What imaging technique is first-line for this diagnosis?

Echocardiography

II. Describe the advantages and disadvantages of this technique for diagnosing pericardial effusion.

Advantages

  • Does not expose patients to ionizing radiation.

  • Highly portable.

  • Offers exquisite detail of the valvular structures and helps measure cardiac chamber pressures further detailing underlying cardiac pathology.

  • Best imaging tool and offers a persistent echo free space between the parietal and visceral pericardium throughout the cardiac cycle.

  • Offers better visualization of frond like, band like, or shaggy intrapericardial echoes in complicated effusions.

Disadvantages

  • Operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • Plain radiography of the chest (PA and lateral view of the chest).

  • CT imaging of the pericardium.

  • Cardiac MR imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pericardial effusion.

Plain radiography of the chest (PA and lateral view of the chest)

Advantages

  • Highly portable.

  • Relatively inexpensive imaging modality.

Disadvantages

  • Has limited sensitivity and specificity for diagnosing pericardial effusion.

  • Fat pad sign on lateral film is less sensitive.

  • Flask shaped enlargement of cardiac silhouette is nonspecific.

  • Offers limited sensitivity in characterizing the surrounding soft tissues, vasculature, and osseous structures.

  • Less adept in directing treatment.

CT imaging of the pericardium

Advantages

  • May help characterize the size and distribution of the effusion.

  • May help characterize the type of effusion.

  • May help detect associated pleural thickening.

  • May help guide treatment and therapy.

Disadvantages

  • Exposes patients to ionizing radiation.

Cardiac MR imaging

Advantages

  • May help characterize the nature of the pericardial effusion and evaluate for any pericardial thickening.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • May be subject to motion artifact due to the cardiac cycle, and must be cardiac gated.

  • Expensive.

  • Time consuming.

VI. What are the contraindications for the alternative imaging techniques?

Plain radiography of the chest (PA and lateral view of the chest)

  • No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant women.

CT imaging of the pericardium

  • May be contraindicated in pregnant patients.

Cardiac MR imaging

  • Contraindicated in patients with non-MR compatible hardware.

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