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Cardiovascular Imaging

Pericardial effusion

accumulation of fluid in the pericardial sac. A large effusion inducing a rise of intrapericardial pressure causes cardiac compression and symptoms of pericardial tamponade. There are many aetologies for effusion including: pericarditis, pericardial infection, pericardial tumours, postpericardiotomy syndrome, radiation, collagen vascular diseases, uraemia, heart failure, chylopericardium and myxoedema. The effusion may be loculated, especially after cardiac surgery. Chest X-ray suggests the diagnosis when there is enlargement of the cardiac silhouette over a short time interval especially in the absence of pulmonary venous hypertension or oedema. The lateral view may show the fat pad sign consisting of separation of the parietal and epicardial fat layers by more than 34 mm. Echocardiography is usually employed for definitive diagnosis. Computed tomography and MRI are very sensitive techniques for demonstrating effusions (Fig.1). Haemorrhagic effusions are characterized by high density on CT and high signal intensity on T1-weighted spin echo MRI (Fig.2).

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Fig.1

ECG-gated spin-echo image shows a large pericardial effusion. This transudative effusion has low signal intensity.
Pericardial effusion, Fig.1
Pericardial effusion, Fig.2