Pericardial Disease - Pericardial Effusion vs Tamponade
Caption
Seen here is a subxiphoid view of a moderate sized, free-flowing pericardial effusion. There is >50% collapsible IVC which makes tamponade less likely in the absence of clinical signs of hemodynamic deterioration (i.e. normal blood pressure, mild tachycardia and pulsus paradoxus <10 mmHg). Plethora of the IVC in pericardial effusion is associated with elevated right heart filling pressures and is more sensitive though less specific for tamponade than right heart chamber collapse or jugular venous distention. Plethora of the IVC also has greater sensitivity than does elevated jugular venous distention on physical examination (97% versus 61%). Reference: Ronald Himelman, Barbara Kircher, Don Rockey, Nelson Schiller. Inferior vena cava plethora with blunted respiratory response: A sensitive echocardiography sign of cardiac tamponade. JACC. 1988; 12:1470-1477. Shahad Al Chalaby, MD (PGY3) @shahad_Chalaby Alameda Health System Internal Medicine Residency Program Oakland, CA