Justin Yaworski, MD

Matt Jones, MD


Image Contributors


Matt Bishop, MD

Barry knapp, MD

Brian Allen, Md


 Garrett GHENT, MD



Shravan KUMAR, MD


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Pericardial Effusion clips and images



Notes from Justin's Draft


Pericardial Effusion

Causes: 1

  • Pericardial effusion can be caused by a variety of diseases and acute conditions including but not limited to infections, primary and metastatic malignancies, myocardial infarction, systemic inflammatory diseases, trauma, aortic dissection


Consequences: 1,2,3

  • The hemodynamic ramifications of a pericardial effusion depend on volume and rate of volume accumulation

    • Small acute changes in effusion volume can lead to tamponade

    • Large sub-acute changes in effusion volume can lead to tamponade

  • Cardiac tamponade

    • Tamponade occurs when the intrapericardial pressure increases to the point at which it impairs cardiac filling

    • The diagnosis of cardiac tamponade is aided by ultrasound, however it is still made clinically

      • Physical Exam findings can include:

        • Chest pain

        • Tachycardia

        • Elevated jugular venous pressure

        • Pulsus paradoxus

        • Hypotension


Echocardiographic signs of cardiac tamponade: 1,2,3

  • RA collapse during atrial systole

  • RV diastolic collapse

  • Reciprocal respiratory changes in RV and LV filling (>25%) and volumes (septal shifting)*

  • Severe dilation of the inferior vena cava


Potential False Positives: 2

  • Left pleural effusion

  • Hematoma

  • Very large left atrium

  • Epicardial fat

  • Left ventricular pseudoaneurysm

  • Hiatal hernia

  • Inferior left pulmonary vein

  • Cysts

  • Foramen of Morgagni hernia (congenital diaphragmatic hernia)


* In the setting of cardiac tamponade, the pressure from an infusion causes a relatively fixed intrapericardial volume. As such, venous return and right-sided filling (atrial and ventricular) occur during inspiration as intrathoracic pressures fall. This causes a shift to the left of the interventricular septum and a marked decrease in left ventricular diastolic filling and stroke volume. During expiration, venous return decreases which allows for filling of the left heart. These changes in reciprocal filling are present in healthy individuals but they are much more prominent during cardiac tamponade, and the variation in left ventricular stroke volume corresponds to the clinical finding of pulsus paradoxus.



  1. Otto CM. Textbook of Clinical Echocardiography. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013.

  2. Maisch B, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004 Apr;25(7):587-610.

  3. Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial Disease: Diagnosis and Management. Mayo Clinic Proceedings. 2010;85(6):572-593. doi:10.4065/mcp.2010.0046.