Pericardial Effusion

  • Etiology: accumulation of fluid (serous, chylous, blood) in pericardial space
  • CXR: water bottle heart, epicardial fat sign is good sign of fluid – see pericardial fluid between outer mediastinal fat + inner epicardial fat
  • Complications: rapid accumulation of 100-200 cc of fluid in pericardial space can cause cardiac tamponade due to diastolic dysfunction
  • Clinical: pericardial space normally has 15-50 cc of fluid, gradual accumulation of fluid in pericardial space can result in more fluid (1500 cc) without serious tamponade, in unexplained code in NICU patient need to rule out cardiac tamponade from upper extremity PICC line eroding into pericardial space as etiology

Cases of Pericardial Effusion

CXR of pericardial effusion
CXR AP shows normal pulmonary vasculature and an enlarged water bottle-shaped heart.
CXR and CT of pericardial effusion
CXR AP shows an enlarged cardiac silhouette, bilateral pleural effusions and radioopaque pellets in the right thorax near the hilum and left axilla. Axial and coronal CT with contrast of the chest shows a large amount of fluid in the pericardial space.