Pericardial effusion – Echocardiography
Pericardial effusion – Echocardiography
Pericardial effusion on echocardiography is typically classified based on size, location, and hemodynamic significance. Here’s a structured breakdown:
1. By Size (based on echo-free space in diastole)
- Small: <10 mm (usually <200 mL of fluid)
- Moderate: 10–20 mm (≈200–500 mL)
- Large: >20 mm (>500 mL)
- Very Large: >25 mm
2. By Distribution
- Circumferential: fluid surrounds the entire heart.
- Loculated: localized collection, often post-surgery, post-trauma, or with infection.
- Posterior only: may be seen in small effusions.
- Anterior only: rare, usually post-operative.
3. By Character (echo appearance)
- Anechoic (clear fluid): usually transudate or serous.
- Echo-dense (heterogeneous, fibrin strands): suggests exudative effusion (infection, malignancy, hemopericardium).
4. By Hemodynamic Significance
- No tamponade: only echo-free space without chamber collapse.
- Pre-tamponade: early diastolic collapse of right atrium/ventricle, but no clinical compromise.
- Cardiac tamponade: right atrial or right ventricular diastolic collapse, plethoric IVC, exaggerated respiratory variation in Doppler inflows.
| Classification | Criteria |
|---|---|
| Size | Small (<10 mm), Moderate (10–20 mm), Large (>20 mm), Very Large (>25 mm) |
| Distribution | Circumferential, Loculated, Posterior only, Anterior only |
| Character | Anechoic (clear), Echo-dense (fibrin, clots, debris) |
| Hemodynamics | No tamponade, Pre-tamponade, Tamponade |
1. A pericardial effusion measuring 8 mm on echo is classified as:
Small effusion = echo-free space <10 mm (<200 mL).
2. A circumferential pericardial effusion means:
Circumferential effusion surrounds the whole heart.
3. Which echo feature suggests cardiac tamponade?
Tamponade = RA/RV collapse + plethoric IVC + Doppler variation.
4. A fibrinous pericardial effusion on echo appears as:
Exudative/hemorrhagic effusion appears echo-dense with fibrin strands.
5. Which is typical of a moderate effusion?
Moderate effusion = 10–20 mm (≈200–500 mL).
6. Very large pericardial effusion is defined as:
Very large effusion = echo-free space >25 mm.
7. Loculated pericardial effusion is most often seen after:
Loculated effusion is common after cardiac surgery or trauma.
8. Posterior-only pericardial effusion is usually:
Small effusions often appear only posteriorly on echo.
9. A transudative effusion appears on echo as:
Transudates are typically anechoic and echo-free.
10. Which Doppler finding supports tamponade?
Tamponade causes exaggerated respiratory variation in ventricular inflow.
11. Which chamber usually collapses first in tamponade?
RA collapse occurs first in tamponade physiology.
12. Which feature favors effusion over epicardial fat?
Effusions collect posteriorly, unlike epicardial fat which is anterior.
13. Plethoric IVC on echo in tamponade means:
Tamponade shows a dilated IVC with poor inspiratory collapse.
14. Most specific sign of tamponade on echo is:
RA/RV diastolic collapse is highly specific for tamponade.
15. Echo-dense pericardial effusion most often indicates:
Echo-dense fluid suggests infection, malignancy, or hemopericardium.
16. Small effusion is usually:
Small effusions (<10 mm) are often posterior-only on echo.
17. What is the most reliable indicator of hemodynamic compromise?
Hemodynamic impact is best judged by collapse patterns + Doppler variation, not size alone.
18. Which effusion is most likely malignant?
Malignant effusions are often large, loculated, and echo-dense.
19. Which best distinguishes pericardial effusion from pleural effusion?
On parasternal long axis, pericardial effusion lies anterior to descending aorta; pleural is posterior.
20. Which of the following is NOT part of echo classification of pericardial effusion?
Classification is by size, distribution, character, and hemodynamic impact—not cholesterol level.
| 📊 Pericardial Effusion – Echocardiographic Classification | |
|---|---|
| By Size |
🔹 Small: <10 mm (<200 mL) 🔹 Moderate: 10–20 mm (200–500 mL) 🔹 Large: >20 mm (>500 mL) 🔹 Very Large: >25 mm |
| By Distribution |
🔹 Circumferential (surrounds heart) 🔹 Loculated (post-surgical/adhesions) 🔹 Anterior only 🔹 Posterior only |
| By Character |
🔹 Anechoic (clear, transudate) 🔹 Echo-dense (fibrin, clots, debris, exudate) |
| By Hemodynamics |
🔹 No Tamponade: echo-free space only 🔹 Pre-Tamponade: RA/RV diastolic collapse, no clinical compromise 🔹 Tamponade: RA/RV collapse + plethoric IVC + Doppler variation |
