II. Definition

  1. Fluid collection around heart within pericardial sac

III. Causes

  1. Pericarditis
    1. See Pericarditis Causes
    2. Malignancy (common)
    3. Connective tissue disease (esp. Rheumatoid Arthritis)
  2. Hemopericardium
    1. Heart surgery from post-operative Hemorrhage (common)
    2. Myocardial Infarction (free wall ventricular rupture)
    3. Aortic aneurysm
    4. Aortic Dissection
    5. Chest Trauma (especially penetrating Chest Injury)
    6. Anticoagulation
  3. Chylopericardium (milky Pericardial Effusion)
    1. Heart surgery from post-operative lymph collection
    2. Malignancy (lymphatic obstruction from heart)

IV. Symptoms and Signs

V. Imaging: Echocardiogram

  1. See Echocardiogram
  2. Features
    1. Pericardial Effusion will surround the heart and should be seen in multiple views
    2. Pericardial fluid moves in opposite direction as heart wall
    3. Cardiac Tamponade
      1. Right heart wall movement appears as a paradoxical rocking motion
      2. Right atrium collapse in systole (also occurs with hypovolemic shock)
      3. Right ventricular collapse in diastole
      4. May appear as a tiny man jumping on right ventricle like a trampoline (PLAX View)
  3. Differential diagnosis (look-alikes on Echocardiogram, confirm in multiple views)
    1. Descending aorta
    2. Pericardial fat pad (moves with heart wall)
      1. Clotted blood may have similar heterogeneous appearance as fat
      2. However clotted blood moves independently of heart wall
  4. Precautions
    1. Even a small Pericardial Effusion (0.5 cm) can cause tamponade
  5. References
    1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete's Beach
    2. Orman, Dawson and Mallin in Majoewsky (2013) EM:Rap 13(1): 4-6

VI. Management: Cardiac Tamponade

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Ontology: Pericardial effusion body substance (C1253937)

Definition (UWDA) Pathological transudate in the pericardial cavity.
Concepts Body Substance (T031)
English Pericardial effusion, pericardial effusion, Pericardial effusion body substance