Detection Of Pericardial Effusion Research Articles

DIAGNOSIS OF PERICARDIAL EFFUSION BY COMPUTED TOMOGRAPHY

We assessed the diagnostic utility of computed tomography (CT) in the detection of pericardial effusion by using a dog model in which the amount and type of pericardial fluid were controlled and by obtaining CT scans on patients with suspected pericardial effusion prior to pericardiocentesis. The experimental studies showed that CT was capable of detecting pericardial effusion composed of serous fluid or saline in amounts as small as 50 ml. However, the hemopericardium was radiographically isodense with the heart and difficult to detect by CT unless the epicardial fat pad was identified or intravenous contrast enhancement of the heart was used. CT clearly demonstrated the presence of pericardial effusion in all six patients studied prior to successful pericardiocentesis or pericardiectomy. We conclude that CT is a sensitive noninvasive method which can be used for the diagnosis of pericardial effusion.

Diagnosis of Pericardial Effusion by Computed Tomography

We assessed the diagnostic utility of computed tomography (CT) in the detection of pericardial effusion by using a dog model in which the amount and type of pericardial fluid were controlled and by obtaining CT scans on patients with suspected pericardial effusion prior to pericardiocentesis. The experimental studies showed that CT was capable of detecting pericardial effusion composed of serous fluid or saline in amounts as small as 50 ml. However, the hemopericardium was radiographically isodense with the heart and difficult to detect by CT unless the epicardial fat pad was identified or intravenous contrast enhancement of the heart was used. CT clearly demonstrated the presence of pericardial effusion in all six patients studied prior to successful pericardiocentesis or pericardiectomy. We conclude that CT is a sensitive noninvasive method which can be used for the diagnosis of pericardial effusion.

Echocardiographic mimicry of pericardial effusion

Echocardiography is a sensitive technique for the detection of pericardial effusion, but the abnormal echocardiographic patterns seen with effusions are not, however, entirely specific for that diagnosis. This study describes four patients in whom anatomic structures, a coronary artery to coronary sinus fistula (one case) and tumors metastatic to pericardium (three cases), produced posterior and, in two cases, anterior spaces compatible with pericardial fluid. Echocardiographic patterns mimicking pericardial effusion have previously been reported in patients with anatomic abnormalities such as mitral anular calcification, pleural effusions, left atrial enlargement, anterior mediastinal or pericardial tumors, foramen of Morgagni hernia and pseudoaneurysm of the left ventricle. It appears that structures of fluid or tissue density, interposed between the heart and the airfilled lung, can produce echocardiographic patterns simulating pericardial effusion.

A historical review of echocardiographic detection of pericardial effusion.

The 26 year history of echocardiographic detection of pericardial effusion ideally demonstrates the scientific method. The initial observations by Elder and Hertz in 1954 lead to animal experiments by Feigenbaum an Soulen many years later. Human applications were confirmed again and again with cardiac catheterization, surgery, autopsy and radiologic procedures. Older methods of effusion detection were compared to this new and noninvasive method and found lacking. Echocardiography has been a safe, reliable and accurate method to establish the presence of pericardial effusion in the symtomatic and asymtomatic patient. It has been used as the diagnostic standard for other detection methods. Investigators and clinicians are now utilizing echocardiography to explain cardiac physiology when pericardial effusion is present; and to follow the effects of their therapeutic interventions. While the presence of pericardial effusion has proven to be more prevalent than expected, the pathologic and hemodynamic significance of unsuspected effusion had not yet been established. Experimental and clinical studies are continuing with the aid of computerized technology for data retrieval and analysis. Thousands of patients are examined yearly with echocardiography and their statistics roll from the pages of scientific and clinical publications. The world's literature is at one's fingertips. But--the echocardiogram and its derived data are only as good as the knowledge and skill of the examiner, technologist and physician alike who " ... must understand the physics of ultrasound, the operation of a complex electronic instrument, the nature of intracardiac anatomy, and clinical cardiology as well as echographic manifestations of normal and disease conditions. Information can seldom be extracted retrospectively from the echocardiogram that was not deliberately depicted at the time of examination." More than a quarter of a century has honed present day skills to record and interpret echocardiographic tracings of pericardial effusion. Yet, it is sobering to consider how primitive our best efforts are compared to methods still unknown which will be used by technologists and physicians fifty years from now.

Unusual echocardiographic findings in pericardial tamponade

M-mode echocardiographic scanning has been known to be a sensitive and reliable technique for the detection of pericardial effusion. 1. 2 The diagnosis is established by the demonstration of an echo-free space between the left ventricle and the posterior pericardium. This space is said to disappear near the left atrioventricular junction on a continuous scan from the apex of the left ventricle to the aortic root. It is generally felt 3 that fluid cannot accumulate behind the left atrium because of the nature of the reflection of the pericardium around the great vessels on the posterior surface of the heart. This report describes a case of pericardial tamponade in which M-mode echocardiography revealed definite fluid behind the left atrium. Other unusual echocardiographic features of this case were apparent prolapse of the mitral valve and markedly exaggerated motion of the heart as a whole. A normal EF slope was recorded despite the presence of pericardial tamponade.

Echocardiographic Interpretation of Pericardial Effusion

Echocardiography has proved to be quite useful in the detection of pericardial effusion. As little as 15 ml of fluid within the pericardial space can be detected. Specific signs of pericardial effusion, such as electrical alternans and paradoxical pulse, have become better understood by echocardiographic study. Yet, with all the benefits of echocardiography, the detection of pericardial effusion still may be quite difficult if careful attention is not given to technique. False-positive diagnosis of anterior pericardial effusion can be seen with epicardial fat pad, pericardial cyst, or foramen of Morgagni hernia. False-positive posterior pericardial effusion can be seen in large left pleural effusion, calcified mitral anulus, or excessively medial transducer angulation. New "switched-gain" circuits have helped detection of pericardial effusion by enhancement of pericardial echoes.

Echocardiographic interpretation of pericardial effusion

Echocardiography has proved to be quite useful in the detection of pericardial effusion. As little as 15 ml of fluid within the pericardial space can be detected. Specific signs of pericardial effusion, such as electrical alternans and paradoxical pulse, have become better understood by echocardiographic study. Yet, with all the benefits of echocardiography, the detection of pericardial effusion still may be quite difficult if careful attention is not given to technique. False-positive diagnosis of<i>anterior</i>pericardial effusion can be seen with epicardial fat pad, pericardial cyst, or foramen of Morgagni hernia. False-positive<i>posterior</i>pericardial effusion can be seen in large left pleural effusion, calcified mitral anulus, or excessively medial transducer angulation. New "switched-gain" circuits have helped detection of pericardial effusion by enhancement of pericardial echoes. (<i>Arch Intern Med</i>138:622-625, 1978)

Ultrasonography in Children

Ultrasound is the manifestation of a high frequency mechanical vibration. The sound waves produced are beyond the range of human hearing, i.e., 1 to 10 mHz. The sound waves travel through liquids and solids but cannot pass through air or vacuum. Ultrasonic energy is produced by a transducer, the power to which is supplied by a high-voltage pulsing circuit in an amplifier (ultrasonoscope). Ultrasonography has been used successfully in the examination of pediatric patients. One of the most common uses has been to measure shifts of the midline structures of the brain. By utilizing the standard echoencephalographic approach established for adults, and positioning the transducer above the ears in the temporoparietal regions, echoes are recorded from the midline structures. Ultrasonography is used as a preliminary study prior to more definitive procedures such as pneumoencephalography or arteriography, particularly in the presence of localizing signs. It has also been used to detect hydrocephalus and to follow changes in ventricular size which occur after ventricular shunting procedures. In fact, this is the easiest way to serially monitor the response to decompression. In many hospitals, ultrasonagraphy is considered to be the primary diagnostic study for the detection of pericardial effusion. Ultrasonic examination of the heart of pediatric patients with suspected congenital or acquired heart disease appears to be a promising new diagnostic technique. It has been successfully used to evaluate a number of abnormalities: great vessel transposition, cardiac chamber size and position, valve motion, and ventricular wall thickness. Extensive research is in progress to establish both normal values and patterns for differentiating various congenital abnormalities.

Echocardiographic M-scan technique in the diagnosis of pericardial effusion.

AbstractM‐scanning was found useful in eight patients in whom the diagnosis of pericardial effusion was negative or equivocal with conventional echocardiography. With the patient in the semi‐recumbent position, the records were obtained while the ultrasound beam was sector scanned base toward the cardiac apex. With this technique, a separation of the posterior pericardium epicardium by a divergent echo‐free space was noted when pericardial effusion was present. The divergent nature of the echo‐free space was due to accumulation of pericardial fluid toward the cardiac apex. The shift of pericardial fluid toward the cardiac apex was further demonstrated by elevation of the patient supine to the semi‐recumbent position. The latter position enhances the sensitivity of M‐scanning in the detection of pericardial effusion.

PERICARDITIS AND PERICARDIAL EFFUSION: Radiologic and Echocardiographic Diagnosis

Since pericardial effusion is the major gross pathologic feature of pericardial disease, detection of pericardial effusion remains a continuing challenge to the radiologist. The plain films and fluoroscopic findings which suggest the possibility of pericardial effusion are briefly reviewed. Conventional angiocardiography, while essential in some cases, is too elaborate for use in every patient who might have a pericardial effusion. Radionuclide angiocardiography, carbon dioxide atriography, and radiopaque contrast atriography are all useful but are less reliable, less complete, and only somewhat less complicated than the conventional study. Echocardiography, where available, is the preferred method for the study of the great majority of patients suspected of having a pericardial effusion. This method not only detects anterior and posterior-inferior fluid collections with accuracy, but also is noninvasive and can be done quickly at the bedside with virtually no movement, discomfort or risk to the patient.

Identification of ultrasound echoes from the left ventricle by use of intracardiac injections of indocyanine green.

This study was designed to identify the ultrasound echoes originating from the left ventricle. Injections of indocyanine green and saline were made directly in the left ventricular cavity via a cardiac catheter in patients undergoing routine diagnostic cardiac catheterization. The injections produced a cloud of echoes that filled the left ventricular cavity and outlined the left side of the interventricular septum and the endocardial surface of the posterior left ventricular wall. The results of this study verified the origin of echoes that are vital to the ultrasound technics for the detection of pericardial effusion, left ventricular wall size, left ventricular cavity size, and left ventricular stroke volume. This study also provided ways of distinguishing between the true left ventricular wall echoes and intracavitary echoes that often cause confusion.

Ultrasound Cardiography: Contrast Studies in Anatomy and Function

Ultrasound cardiography has become established as a valuable clinical tool in the detection of pericardial effusion (1) and the study of mitral valve disease (2, 3). The tricuspid valve can also be detected (4), and studies have been made of left ventricular stroke volume (5) and wall thickness (6). On the other hand, the extension of the ultrasonic method to the study of other cardiac structures has been slow because of the difficulty in recognizing the source of the echoes. Even here, however, Edler (7) has gained useful knowledge in the recognition of the origin of these echoes by the passing of needles into cadavers in duplication of the path of the ultrasonic beam and by the study of excised hearts. The purpose of this presentation is to describe a method for the ultrasonic identification of the cardiac chambers in the living subject. It is based on the intracardiac injection of substances that produce echoes at the site of injection as well as downstream in the flow pattern and permit identification...

Evaluation of right atriography for the detection of pericardial effusion.

Evaluation of right atriography for the detection of pericardial effusion.

Pericardial effusion diagnosed by reflected ultrasound

This paper presents an evaluation of the use of reflected ultrasound in the detection of pericardial effusion in 30 patients. The patients were divided into two groups. Group A consisted of 19 patients whose effusion was confirmed by another procedure. Group B, 11 patients, had serial ultrasonic studies performed to confirm the presence of pericardial effusion. Two patients with a false positive diagnosis of pericardial effusion are included, and the reasons for the faulty diagnoses are discussed. Our evaluation of this technic suggests that reflected ultrasound can be used to diagnose pericardial effusions of smaller amounts than other technics now widely used. The technic also appears to be of great help during pericardiocentesis in that it can quickly tell the clinician whether the fluid has been completely removed or if a change in the direction of the needle or position of the patient will increase the yield of fluid.

The echocardiogram: An ultrasound technique for the detection of pericardial effusion

The echocardiogram: An ultrasound technique for the detection of pericardial effusion

Blood-pool scanning with technetium-199m human serum albumin.

The radioisotope blood pool scan has been applied to two principal kinds of problems: the differential diagnosis of midline masses (1) and, more commonly, the detection of pericardial effusions (2, 3). In the latter application, however, it has recently fallen out of favor compared with alternative roentgenographic methods which employ intravenously injected carbon dioxide or iodine-containing drugs as contrast materials. The isotope scan has languished because of the length of time required to perform it and because detection of effusions less than 250–300 ml in size was difficult even under ideal laboratory circumstances (3) and perhaps impossible in vivo. Many laboratories have investigated a number of tracer elements characterized by relatively short half-lives and low photon energies. Such tracers for any particular test will assure relatively low whole-patient and organ radiation doses, and they may therefore often be used in quantities large enough to supply good counting rates and improved scannin...

Ante-mortem demonstration of hepatic-vein distention.

Intravenous injection of carbon dioxide for detection of pericardial effusion is not a new technic.1 , 2 This method, as used at the Lemuel Shattuck Hospital during the past two and a half years, h...

Radioisotope scanning in the detection of pericardial effusions.

The development of a new method for scintillation detection of pericardial fluid is described. A model system is used in which heart and pericardium are simulated by a pair of readily distensible rubber balloons, one inside the other. Radioisotope scintillation scanning of the blood pools of the heart can best be performed by employing a scanning apparatus which affords a large, well-shielded thallium-activated Nal crystal, a focusing collimator, and a cathode-ray tube photographic printing system with circuits for modifying contrast and density. The 74 min biologic half life of I/sup 131/-labeled iodipamide (Cholografin) reduces greatly the radiation dose delivered to the patient and permits using tracers of the order of 750 μC, increasing the number of counts in the area of interest.

Angiocardiographic Findings in Pulmonary Tuberculosis

The angiocardiographic findings in 91 tuberculous patients studied during life are presented. Diminished vascularity of varying degrees was found to occur in local areas of the lung involved by tuberculosis. The degree of avascularity depended upon the amount of lung tissue involved. The more widespread the parenchymal lesion, the more marked was the avascularity. Displacement of vessels secondary to fibrosis and retraction was encountered frequently. In tuberculous fibrothorax, angiocardiography delineates the cardiac chambers and great vessels, often revealing marked distortion and displacement of these structures. By contrast visualization, hilar and mediastinal masses may be differentiated from aneurysm. In two instances tuberculous hilar and mediastinal adenopathy resulted in obstruction of major branches of the pulmonary artery. Finally, the use of angiocardiography in the detection of pericardial effusion is illustrated.