Detection Of Pericardial Effusion Research Articles

Automated Evaluation for Pericardial Effusion and Cardiac Tamponade with Echocardiographic Artificial Intelligence.

Timely and accurate detection of pericardial effusion and assessment cardiac tamponade remain challenging and highly operator dependent. Artificial intelligence has advanced many echocardiographic assessments, and we aimed to develop and validate a deep learning model to automate the assessment of pericardial effusion severity and cardiac tamponade from echocardiogram videos. We developed a deep learning model (EchoNet-Pericardium) using temporal-spatial convolutional neural networks to automate pericardial effusion severity grading and tamponade detection from echocardiography videos. The model was trained using a retrospective dataset of 1,427,660 videos from 85,380 echocardiograms at Cedars-Sinai Medical Center (CSMC) to predict PE severity and cardiac tamponade across individual echocardiographic views and an ensemble approach combining predictions from five standard views. External validation was performed on 33,310 videos from 1,806 echocardiograms from Stanford Healthcare (SHC). In the held out CSMC test set, EchoNet-Pericardium achieved an AUC of 0.900 (95% CI: 0.884- 0.916) for detecting moderate or larger pericardial effusion, 0.942 (95% CI: 0.917-0.964) for large pericardial effusion, and 0.955 (95% CI: 0.939-0.968) for cardiac tamponade. In the SHC external validation cohort, the model achieved AUCs of 0.869 (95% CI: 0.794-0.933) for moderate or larger pericardial effusion, 0.959 (95% CI: 0.945-0.972) for large pericardial effusion, and 0.966 (95% CI: 0.906-0.995) for cardiac tamponade. Subgroup analysis demonstrated consistent performance across ages, sexes, left ventricular ejection fraction, and atrial fibrillation statuses. Our deep learning-based framework accurately grades pericardial effusion severity and detects cardiac tamponade from echocardiograms, demonstrating consistent performance and generalizability across different cohorts. This automated tool has the potential to enhance clinical decision-making by reducing operator dependence and expediting diagnosis.

Adult Onset Still’s Disease Revealed by a Cardiac Tamponade: A Case Report

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease of unknown origin with various clinical manifestations. In this article, we describe a case of 57-year-old presenting with Still's disease complicated by cardiac tamponade.
 This case highlights the importance of a prompt diagnosis of cardiac involvement in inflammatory diseases, as it can be fatal, and underlines the utility of echocardiographic evaluation not only in symptomatic patients, but also for the systematic detection of pericardial effusions. The case of hemodynamic compromise, it allows the provider to determine the timing, approach, and method of pericardial drainage due to cardiac tamponade being a very rare complication that requires an invasive approach.

Cardiac tamponade: an unexpected onset of acute lymphoblastic leukemia (case report)

Prompt diagnosis of cardiac tamponade is of critical importance, as the underlying hemodynamic alteration may prove fatal. This case report describes the presentation of a young man with symptoms of heart failure, in whom cardiac tamponade was discovered as a harbinger of a hematologic malignancy. Further investigations confirmed the diagnosis of T-cell acute lymphoblastic leukemia. Despite chemotherapy, the patient developed severe complications and ultimately succumbed. The purpose of this report is to raise awareness that hematologic malignancies can manifest with pericardial effusions and to highlight the value of echocardiography in the evaluation of patients with leukemia. It is recommended that echocardiography be used not only for pre- and post-chemotherapy assessment, but also for routine detection of pericardial effusions and, in the event of hemodynamic compromise, to determine the timing, approach, and method of pericardial drainage.

MO824: Utility of Novel Wireless Mobile Ultrasound Technology Via Nephrologists in Egyptian Hemodialyis Patients

Abstract BACKGROUND AND AIMS Ultrasound and ultrasound-guided procedures are being widely applied in the field of clinical and interventional nephrology [1]. Many nephrology training programs still lack structured ultrasound training. Handheld mobile ultrasound provides affordability and ease of usage of the techniques [2]. To test the feasibility of hand-held mobile ultrasound in detecting incidental asymptomatic arterio-venous (AV) access or parathyroid gland as well as assessing volume status and detection of pericardial effusion [3]. METHOD We recruited 344 patients with end-stage renal disease undergoing regular hospital haemodialysis. Informed consents for the procedure were obtained from all patients. All patients have undergone post-session chest ultrasound, bedside cardiac ultrasound to detect pericardial effusion, neck ultrasound to detect parathyroid adenoma and arterio-venous access ultrasound scanning. All ultrasound scanning was done by the same operator using: high frequency head (curvilinear head) to examine parathyroid glands, AV access and lung ultrasound. Low frequency (linear head) to examine the abdomen and pelvis and to detect pericardial effusion. RESULTS Lung ultrasound scanning detected pleural effusion in 3 patients and an increase in the B line in 12 patients. Pericardial effusion was detected in one patient. Parathyroid adenoma in one patient. Native AVF access stenosis in three patients and pseudo-aneurysm of AVG in one patient. CONCLUSION The use of handheld mobile ultrasound via mobile application enabled an easy and fast way to scan a large number of haemodialysis patients and detect asymptomatic pleural effusion, pericardial effusion, AV access malfunction and parathyroid adenomas. The integration of mobile ultrasound techniques into the care of end-stage renal disease on haemodialysis may be of significant added on value.

INCIDENTAL DIAGNOSIS OF PERICARDIAL EFFUSION ON ENDOBRONCHIAL ULTRASOUND

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Endobronchial Ultrasound (EBUS) is a state-of-the-art diagnostic tool for diagnosing and staging lung cancer and can recognize several structures of the mediastinum; lymph nodes, tumors, vessels, pericardium, and the heart. We herein report a case of an incidental de-novo finding of pericardial effusion seen during the EBUS. CASE PRESENTATION: A 55 year old male with a history of tobacco abuse presented to the clinic with worsening dyspnea, fatigue, cough, and weight loss, and a contrast-enhanced CT scan of the chest showed right lower lobe lung mass with enlarged mediastinal and hilar nodes. Pulmonary service was consulted, and the patient underwent a successful EBUS bronchoscopy with a fine need aspiration of the enlarged lymph nodes. EBUS imaging from the sub-carinal region through the anterior wall of the left lower lobe bronchus showed pericardial effusion and, the pericardium was identified above the left atrium. The patient underwent an urgent echocardiogram confirming pericardial effusion and pericardiocentesis drained 1200 ml fluid later proved to be metastatic adenocarcinoma of lung origin. DISCUSSION: EBUS is increasingly used to evaluate mediastinal lesions, diagnose and staging malignancy. Pericardiocentesis under echocardiographicGuidance is considered the procedure of choice for the evacuation of pericardial effusions. Given the advantage of visualizing pericardium and heart during the EBUS, multiple reports have documented aspiration of pericardial effusion through a regular EBUS-TBNA needle. CONCLUSIONS: We here report a rare case of incidental pericardial effusion seen during the EBUS and highlight the possibility of detecting pericardial effusions early as several mediastinum structures: lymph nodes, tumors, vessels, pericardium, and the heart are visualized during the EBUS. Therefore, physicians must be aware of the alternative use of EBUS as a new diagnostic approach in the early detection of pericardial effusions, allowing for early initiation of therapy in an otherwise potentially life-threatening condition. REFERENCE #1: (EBUS) Application for Benign and Malignant Pericardial Effusion (PE) Aspiration: Transbronchial Pericardial Effusion Aspiration (TPEA) with a Regular EBUS Transbronchial (TBNA) Needle under Apneic Nasal Jet-Catheter Ventilation.” J Biomed 1 (2016): 9-25. REFERENCE #2: Sharma, Rahul K., Arjun Khanna, and Deepak Talwar. "Endobronchial Ultrasound: A New Technique of Pericardiocentesis in Posterior Loculated Pericardial Effusion.” Chest 150.5 (2016): e121-e123. REFERENCE #3: Gella, Vishwanath, Snigdha Ghana, and Upendra Srinivas. "Concurrent diagnostic pericardiocentesis and subcarinal mediastinal lymph node aspiration by EBUS TBNA.” (2015). DISCLOSURES: No relevant relationships by Venkatkiran Kanchustambham, source=Web Response No relevant relationships by Swetha Saladi, source=Web Response No relevant relationships by Vinita Vaidya, source=Web Response

Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania

BackgroundPoint-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device.MethodsOver a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard.Results8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0–94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from − 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement).ConclusionsThe 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.

New Clinical Classification for Ventricular Free Wall Rupture following Acute Myocardial Infarction.

Ventricular free wall rupture (FWR) is a catastrophic complication after acute myocardial infarction (AMI). However, patients with FWR die of cardiac tamponade secondary to intrapericardial hemorrhage that can be treated if properly diagnosed. Unfortunately, FWR was still not diagnosed and classified quickly and accurately. The aim of this study was to present a new clinical classification for FWR. Seventy-eight patients with FWR after STEMI were enrolled in the study. We classified FWR, according to clinical situations after onset, into the cardiac arrest type, unstable type, and stable type. The cardiac arrest type was the most common type, accounting for about 83.3%. 90.8% of patients of this type were complicated with electromechanical dissociation at the time of FWR onset, and 100% of patients of this type died in the hospital. The unstable type was characterized by sudden clinical condition changes with moderate/massive pericardial effusion. In this study, 9.0% of patients were diagnosed as the unstable type. The average time from onset to death was 4.5 hours. This period was the “golden time” to rescue such patients. The stable types usually have stable hemodynamics, but may worsen, requiring rigorous detection of pericardial effusion and vital signs. In this study, 7.7% of patients were diagnosed as the stable type, and 83.5% of them survived in the hospital. The new clinical classification provides a basis for clinical diagnosis and treatment of FWR. The clinical application of the new classification is expected to improve the prognosis of FWR patients.

Urgent Surgical Treatment of Blunt Chest Trauma Followed by Cardiac and Pericardial Injuries.

Introduction:Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated. Aim:To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries.Methods:At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 – 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test.Statistical methods used:descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation). Results:Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion.Conclusion:Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the “gold standard” in the treatment of blunt cardiac and pericardial injuries.

Point-of-care ultrasound diagnosis of thoracic aortic aneurysm in a patient presenting with hemoptysis

IntroductionHemoptysis is rarely reported as the chief complaint of thoracic aortic aneurysm (TAA). It usually occurs due to aneurysm erosion into the lung parenchyma or rupture into the lung [1]. Point-of-care ultrasound (POC-US) is now widely used by emergency physicians (EP) to help diagnose life-threatening cardiovascular pathologic conditions.Case ReportA 78-year-old bedridden man with a past history of hypertension and traumatic intracranial hemorrhage presented to the emergency department with massive hemoptysis that was preceded by intermittent hemoptysis for the past 3 days. On arrival, his vital signs were as follows: respiratory rate, 18 breaths/min; pulse rate, 92 beats/min; blood pressure, 82/56 mmHg; and temperature, 36.0 celsius degrees. His consciousness level was clear. POC-US was performed by EP, which revealed a proximal thoracic aortic aneurysm with extraluminal area of heterogeneous echogenicity adjacent hematoma. Subsequent computed tomography angiography (CTA) of the aorta confirmed the diagnosis. The patient and his family refused operation, and he died the same day.DiscussionThe vast majority of patients with thoracic aortic aneurysms are asymptomatic [2]. When symptoms occur, classic manifestations are chest or upper back pain or symptoms related to compression of local structures leading to nerve dysfunction or vessel compression. Hemoptysis is uncommon as the sole presentation of thoracic aortic aneurysm [1,3]. The traditional imaging modalities of choice for TAA include CTA, magnetic resonance imaging, and transesophageal echocardiography. In the recent decades, EP have performed POC-US not only for the detection of pericardial effusion, cardiac function, and abdominal aorta but also for the evaluation of the thoracic aorta. Nowadays, POC-US plays an important role in initiating emergent treatment and triage decisions in the emergency department. EP should carefully consider the atypical presentation of aortic aneurysms and dissection and the applicability of POC-US for first-line decision-making. Hemoptysis is rarely reported as the chief complaint of thoracic aortic aneurysm (TAA). It usually occurs due to aneurysm erosion into the lung parenchyma or rupture into the lung [1]. Point-of-care ultrasound (POC-US) is now widely used by emergency physicians (EP) to help diagnose life-threatening cardiovascular pathologic conditions. A 78-year-old bedridden man with a past history of hypertension and traumatic intracranial hemorrhage presented to the emergency department with massive hemoptysis that was preceded by intermittent hemoptysis for the past 3 days. On arrival, his vital signs were as follows: respiratory rate, 18 breaths/min; pulse rate, 92 beats/min; blood pressure, 82/56 mmHg; and temperature, 36.0 celsius degrees. His consciousness level was clear. POC-US was performed by EP, which revealed a proximal thoracic aortic aneurysm with extraluminal area of heterogeneous echogenicity adjacent hematoma. Subsequent computed tomography angiography (CTA) of the aorta confirmed the diagnosis. The patient and his family refused operation, and he died the same day. The vast majority of patients with thoracic aortic aneurysms are asymptomatic [2]. When symptoms occur, classic manifestations are chest or upper back pain or symptoms related to compression of local structures leading to nerve dysfunction or vessel compression. Hemoptysis is uncommon as the sole presentation of thoracic aortic aneurysm [1,3]. The traditional imaging modalities of choice for TAA include CTA, magnetic resonance imaging, and transesophageal echocardiography. In the recent decades, EP have performed POC-US not only for the detection of pericardial effusion, cardiac function, and abdominal aorta but also for the evaluation of the thoracic aorta. Nowadays, POC-US plays an important role in initiating emergent treatment and triage decisions in the emergency department. EP should carefully consider the atypical presentation of aortic aneurysms and dissection and the applicability of POC-US for first-line decision-making. Figure 1. POC-US of suprasternal notch view showed a proximal thoracic aortic aneurysm with extraluminal area of heterogeneous echogenicity adjacent hematoma (arrow). Figure 2. CTA of the aorta revealed proximal ruptured thoracic aortic aneurysm with adjacent hematoma.•Sun D, Mehta S. Hemoptysis caused by erosion of thoracic aortic aneurysm. CMAJ. 2010; 182:186.•Pressler V, McNamara JJ. Aneurysm of the thoracic aorta. Review of 260 cases. J Thorac Cardiovasc Surg 1985; 89:50.•Nair G, Jindal S, Chandra A, Swami S, Garg P. Haemoptysis - a rare presentation of aortic aneurysm. Lung India. 2008;25:20.

Incidence of Malignancy Related Pericardial Effusion in a Tertiary Hospital

Back ground: Malignancy related pericardial effusion (PE) may represent a terminal event in patients with therapeutically unresponsive disease. Pericardial tamponade (PT) is a co morbid condition in many diagnosed malignant cases. Selection of patients with malignancies who are responsive to available treatment may achieve significant improvement in palliation. Early detection of pericardial tamponade and appropriate intervention (Pericardiocentesis) or Subxyphoid pericardiotomy may result long term survival benefit.Objective: Early detection and management of PE and tamponade in malignant cases.Methods: Color Doppler (C-D) echocardiography was done in 260 patients with underlying malignancies on chemo or radiotherapy from oncology department of Delta Medical college and hospital from May 2016 to December 2016. These cases were reviewed retrospectively for clinical features, diagnosis and therapy for their malignancy.Results: 81% have shortness of breath, sign of pulsus paradoxus and pericardial tamponade were found in 22% and 5% patients respectively. During echocardiography, pericardial effusion was found in 102 patients. 65% have mild pericardial effusion, whereas 27% have moderate and 8% have severe PE. Effusions with malignancy comprising of 40% adenocarcinomas of lung, 15% carcinoma (Ca) of pharynx, 10% Ca breast, 10% lymphoma, 10% is Carcinoma of unknown primary, 8% Ca esophagus and 7% others (Renal, Hepatic, ovary &amp; cheek).University Heart Journal Vol. 12, No. 1, January 2016; 23-25

Unexpected detection of pericardial effusion on myocardial perfusion scintigraphy.

Unexpected detection of pericardial effusion on myocardial perfusion scintigraphy.

The use of the diaphragmatico-hepatic (DH) views of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) examinations for the detection of pericardial effusion in 24 dogs (2011-2012).

To evaluate the clinical usefulness of the diaphragmatico-hepatic (DH) view of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) in detecting pericardial effusion (PE) in dogs. Retrospective case series from 2011 to 2012. Private practice emergency and critical care hospital. Twenty-four dogs with PE diagnosed by FAST. None. Fifty-two medical records from October 1, 2011 through September 30, 2012 had the terms "PE" within the medical record. Twenty-four dogs were diagnosed with PE by FAST with entries for the DH view. Of the 24 dogs, 7 had abdominal FAST, 6 had thoracic FAST (TFAST), and 11 had both exams performed. PE was noted on the DH view in 20 of 24 (83%) cases. Subjective PE volume assessment ranged from trivial (<5 mm) to severe. Of the 4 cases in which PE was absent via the DH view, PE was seen during the same exam at the TFAST pericardial views (n = 2) or detected on serial exam at the DH view (n = 2). The PE volume that was missed via the DH view was characterized as trivial (<5 mm; n = 1), mild (n = 1), and moderate (n = 2). The DH view of FAST was found to be clinically helpful for the detection of PE. Veterinarians should make it routine practice and part of FAST training to look into the thorax via the DH view during both abdominal FAST and TFAST exams.

Difficulties encountered by physicians in interpreting focused echocardiography using a pocket ultrasound machine in prehospital emergencies

Pocket ultrasound devices (PUDs) increase the scope of transthoracic echocardiography. We assessed the ability of emergency physicians (EPs) to obtain and interpret views using PUDs in prehospital emergencies. Nine EPs underwent a 2-day training program focused on acquisition of four views and on evaluation of left ventricular function, right ventricular size, the inferior vena cava, and detection of pericardial effusion. Then, EPs used a PUD to perform transthoracic echocardiography in patients with shock or acute respiratory failure. The quality and interpretation of views were graded by an expert as not obtained/inadequate, adequate, or optimal. Agreement between the expert and the physicians was evaluated using Cohen's κ test. One hundred consecutive exams were evaluated in patients with shock or acute respiratory failure. Parasternal long-axis and short-axis views, and a subcostal view were not obtained or inadequate in 56, 54, and 54 patients, respectively. An apical four-chamber view was not obtained or inadequate in 33 patients. One, two, or three views were graded as adequate or optimal in 86, 65, and 35 patients. Agreement between physicians and experts for left ventricular systolic function, right ventricular size, and pericardial effusion was weak [κ 0.37 (0.17; 0.59), 0.27 (0.023; 0.53), and 0.33 (-0.008; 0.67)]. Agreement for inferior vena cava evaluation was very weak [0.13 (-0.17; 0.43)]. After a very short training program, echocardiography using a PUD in prehospital emergencies was feasible in half of patients. Acquisition of technical skills is reasonable, but accurate evaluation of cardiac function may require more extensive training.

Moderate Pericardial Effusions After Heart Transplant: Do They Require Proactive Intervention?

Background: The development of pericardial effusion after heart transplantation occurs in approximately 15% of patients. Post-surgical inflammation as well as use of calcinuerin inhibitors have been associated with these pericardial effusions. It is not uncommon to have moderate pericardial effusions, meaning those that are between 1 and 2 cm in circumferential diameter on echocardiography. It is not known whether pericardial effusions of this magnitude resolves spontaneously or whether they progress to the point of cardiac tamponade requiring pericardiocentesis or pericardial window placement. Methods: Between 2008 and 2012 we evaluated 292 patients within the first 6 months post heart transplant for the development of moderate pericardial effusions and followed their course for the ensuing year. Outcomes were documented as: pericardial effusion resolving without intervention, pericardial effusion persisiting without intervention and pericardial effusion worsening requiring intervention. Results: We found 33 (11.3%) heart transplant patients who had developed moderate pericardial effusion within the first 6 months post-transplant. The average time to detection of pericardial effusion was 22.4 ± 18.4 days. In follow up, 78.8 % had resolution of the pericardial effusion, 9.1% had no change (at 1 year follow up), and 12.1% had worsening of pericardial effusion requiring either pericardiocentesis (3 patients) or pericardial window placement (1 patient) (see table). All patients were given a trial of diuretics to reduce the effect of the pericardial effusion prior to intervention and were initiated with tacrolimus and mycophenolate as immunosuppression.Table: No Caption available.Conclusion: The development of moderate pericardial effusion after heart transplantation resolves in a majority of cases and therefore does not necessarily require proactive invasive intervention. However, close follow up is advised. DISCLOSURES:Patel, J.: Grant/Research Support, Alexion Pharmaceuticals. Chang, D.: Grant/Research Support, Abbott Pharmaceuticals. Esmailian, F.: Grant/Research Support, Transmedics, Inc. Kobashigawa, J.: Grant/Research Support, XDx, Inc., Novartis Pharmaceuticals, Transmedics, Inc.

Whether Echocardiographic Detection 0f Small Pericardial Effusion is Supporting in Diagnosing Kawasaki Disease

Whether Echocardiographic Detection 0f Small Pericardial Effusion is Supporting in Diagnosing Kawasaki Disease In pediatric patients, small pericardial effusion commonly occurs in various conditions. This finding has been used as a supplemental criterion for Kawasaki disease (KD) diagnosis. We investigate whether the detection of small pericardial effusion has limited value in diagnosis of KD. Method: A prospective echocardiogram study was performed in two groups young children, specifically children in Group 1 were recruited from the well child clinic while Group 2 was KD patients. The echocardiogram was obtained to define pericardial effusion during systole and diastole. Result:Eighty-seven children (mean age 2.2 years, male: 63%) were enrolled in this study. Group 1 comprised 64 children, 24 children had a mild upper respiratory tract infection (URI).While 23 children were in Group 2, 11 of them had incomplete KD. Pericardial effusion detected during systole was visualized in 40.6 % of Group 1 and 43.5% of Group 2 (p=0.81). In Group 1, 66.7% of children with URI were found to have pericardial effusion during systole compared to 25% in the normal healthy children (p=0.001). The rate of detected small pericardial effusion during systole in URI children was similar to KD group (63.6%, p=1.00). In contrary, the detection of pericardial effusion throughout cardiac cycle including diastolic phase was found only in 13% of Group 2 whereas none in Group 1 (p =0.02). Conclusion:Defining small pericardial effusion only during systole is quite accustomed among young children. The pericardial effusion detected during diastole is quite uncommon but is a more explicit finding in children with KD .

Performance of emergency physicians in point-of-care echocardiography following limited training

ObjectivesThe aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department...

Diagnosis of Pericardial Effusion with a New Generation Hand-Carried Ultrasound Device in Cardiothoracic Intensive Care Unit Patients

Technological advances introduced hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several benefits such as fast bedside availability and prompt diagnosis. To evaluate the diagnostic yield of a latest generation HCU imager compared to contrast-enhanced multidetector computed tomography (MDCT) for the detection of pericardial effusion (PE) in cardiothoracic intensive care unit (ICU) patients. Thirty-six patients from a cardiothoracic ICU were enrolled to this study irrespective of their underlying disease. All patients were examined with a new generation HCU for the presence of PE. Definite diagnosis of PE was based on findings of MDCT as standard of reference. Statistical analysis was performed using PASW 18. PE was identified in 20 patients by MDCT (prevalence 56%). The HCU examination was carried out technically successfully in all patients. Sensitivity, specificity, positive and negative predictive value of HCU for the diagnosis of PE were 75%, 88%, 88%, and 74%, respectively. HCU provides rapid, practical, reliable, and cost-effective diagnosis of PE in patients on cardiothoracic ICU.

Accuracy of radiographic vertebral heart score and sphericity index in the detection of pericardial effusion in dogs

To evaluate the diagnostic accuracy of radiographically derived measurements of vertebral heart score (VHS) and sphericity index (SI) in the detection of pericardial effusion (PE) in dogs. Retrospective case-control study. Animals-51 dogs with PE associated with various cardiac disorders, 50 dogs with left- or right-sided cardiac disorders without PE, 50 dogs with bilateral cardiac disorders without PE, and 50 healthy dogs. Measurements of VHS on lateral (lateral VHS) and ventrodorsal (ventrodorsal VHS) radiographs, SI on lateral (lateral SI) and ventrodorsal (ventrodorsal SI) radiographs, and global SI (mean of lateral SI and ventrodorsal SI) were obtained. Receiver operating characteristic curves were calculated to evaluate the diagnostic accuracy of the radiographic indexes at differentiating dogs with PE from those with other cardiac disorders without PE. Measurements of lateral and ventrodorsal VHS were significantly higher in dogs with PE, compared with values for all dogs without PE. Measurements of lateral, ventrodorsal, and global SI were significantly lower in dogs with PE, compared with values for all dogs without PE. Cutoff values of > 11.9, > 12.3, and ≤ 1.17 for lateral VHS, ventrodorsal VHS, and global SI, respectively, were the most accurate radiographic indexes for identifying dogs with PE. Cardiac silhouettes of dogs with PE were larger and more rounded, compared with those of dogs with other cardiac disorders without PE. Objective radiographic indexes of cardiac size and roundness were only moderately accurate at distinguishing dogs with PE from dogs with other cardiac disorders without PE.

The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade

This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.

Point-of-care ultrasound evaluation of pericardial effusions: Does this patient have cardiac tamponade?

Detection of pericardial effusions using point-of-care focused echocardiography is becoming a common application for clinicians who care for critical patients. Identification of tamponade physiology is of great utility, as these patients require urgent evaluation and management. We describe techniques that the point-of-care clinician sonographer can use to determine the presence or absence of echocardiographic evidence of cardiac tamponade.