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Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med 2022; 58:159-174. [DOI: 10.1016/j.ajem.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022] Open
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eFAST exam errors at a level 1 trauma center: A retrospective cohort study. Am J Emerg Med 2021; 49:393-398. [PMID: 34325179 DOI: 10.1016/j.ajem.2021.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/01/2021] [Accepted: 07/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Extended Focused Assessment with Sonography for Trauma (eFAST) ultrasound exams are central to the care of the unstable trauma patient. We examined six years of eFAST quality assurance data to identify the most common reasons for false positive and false negative eFAST exams. METHODS This was an observational, retrospective cohort study of trauma activation patients evaluated in an urban, academic Level 1 trauma center. All eFAST exams that were identified as false positive or false negative exams compared with computed tomography (CT) imaging were included. RESULTS 4860 eFAST exams were performed on trauma patients. 1450 (29.8%) were undocumented, technically limited, or incomplete (missing images). Of the 3410 remaining exams, 180 (5.27%) were true positive and 3128 (91.7%) were true negative. 27 (0.79%) exams were identified as false positive and 75 (2.19%) were identified as false negative. Of the false positive scans, 7 had no CT scan and 8 had correct real-time trauma paper documentation of eFAST exam results when compared to CT and were excluded, leaving 12 false positive scans. Of the false negative scans, 11 were excluded for concordant documentation in real-time trauma room paper documentation, 20 were excluded for no CT scan, and 2 were excluded as incomplete, leaving 42 false negative scans. Pelvic fluid, double-line sign, pericardial fat pad, and the thoracic portion of the eFAST exam were the most common source of errors. CONCLUSION The eFAST exams in trauma activation patients are highly accurate. Unfortunately poor documentation and technically limited/incomplete studies represent 29.8% of our eFAST exams. Pelvic fluid, double-line sign, pericardial fat pad, and the thoracic portion of the eFAST exam are the most common source of errors.
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Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965-1012.e15. [PMID: 23998693 DOI: 10.1016/j.echo.2013.06.023] [Citation(s) in RCA: 405] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Peres Claro I, Magalhães V, Correia I, Campos P, Sotto-Mayor R, Bugalho de Almeida A. Enfarte da gordura epipericárdica – A propósito de um caso clínico. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Nguyen T, Kumar K, Francis A, Walker JR, Raabe M, Zieroth S, Jassal DS. Pseudo cardiac tamponade in the setting of excess pericardial fat. Cardiovasc Ultrasound 2009; 7:3. [PMID: 19161596 PMCID: PMC2632988 DOI: 10.1186/1476-7120-7-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/22/2009] [Indexed: 11/29/2022] Open
Abstract
Cardiac tamponade is the phenomenon of hemodynamic compromise caused by a pericardial effusion. Following a myocardial infarction, the most common causes of pericardial fluid include early pericarditis, Dressler's syndrome, and hemopericardium secondary to a free wall rupture. On transthoracic echocardiography, pericardial fluid appears as an echo-free space in between the visceral and parietal layers of the pericardium. Pericardial fat has a similar appearance on echocardiography and it may be difficult to discern the two entities. We present a case of a post-MI patient demonstrating pseudo tamponade physiology in the setting of excessive pericardial fat.
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Affiliation(s)
- Thang Nguyen
- Section of Cardiology, Department of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Karia DH, Xing YQ, Kuvin JT, Nesser HJ, Pandian NG. Recent role of imaging in the diagnosis of pericardial disease. Curr Cardiol Rep 2002; 4:33-40. [PMID: 11743920 DOI: 10.1007/s11886-002-0124-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noninvasive cardiac imaging techniques have made a striking impact on the evaluation and management of pericardial disorders. Two-dimensional and Doppler echocardiography are the methods of choice in the evaluation of pericardial effusion and cardiac tamponade. Magnetic resonance imaging, computed tomography, and transesophageal echocardiography are valuable in the assessment of pericardial thickness in suspected cases of constrictive pericarditis. Filling dysfunction associated with constrictive pericarditis is well demonstrated by Doppler flow velocity recordings of intracardiac flow jets, and pulmonary and hepatic venous flow streams. Tissue Doppler echocardiography, by which tissue velocity of myocardial regions and mitral annulus are analyzed, offers additional information in the differentiation of constrictive pericarditis and restrictive cardiomyopathy. Magnetic resonance imaging and computed tomography are the techniques of choice in the recognition of unusual disorders such as pericardial cysts, tumors invading the pericardium, and congenital absence of pericardium. Noninvasive imaging aids not only in the diagnosis of pericardial diseases, but also in the guidance of optimal therapy.
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Affiliation(s)
- Darshak H Karia
- Tufts-New England Medical Center, Box 32, 750 Washington Street, Boston, MA 02111, USA
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Abstract
Obesidade é uma doença complexa, de mútiplas etiologias e suficientemente comum para constituir um problema de saúde pública, assim como um dilema clínico importante. Especialistas da área clínica e cirúrgica são freqüentemente desafiados pelas alterações fisiopatológicas associadas com a obesidade. Essas alterações comprometem virtualmente todos os sistemas do organismo, podendo apresentar-se como barreiras no diagnóstico e na terapêutica. Há evidências marcantes de que obesidade acarreta risco excessivo para a saúde; de fato, a mortalidade aumenta de forma aguda quando o índice de massa corporal ultrapassa 30 kg/m2, principalmente quando há distribuição central de tecido adiposo concomitante. O autor discute os efeitos da obesidade nos sistemas respitatório, cardiovascular, digestório e geniturinário. Os obstáculos enfrentados em procedimentos diagnósticos ordinários, prescrição de medicamentos, traumas, assim como descrições patológicas raras de lipomas, são apresentados.
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Kuvin JT, Basu AK, Khabbaz KR, Homoud MK, Pandian NG. Benign lipid envelope of the heart simulating a pericardial hematoma. J Am Soc Echocardiogr 2001; 14:234-6. [PMID: 11241021 DOI: 10.1067/mje.2001.108934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The hallmark of diagnosing a pericardial effusion by echocardiography is the presence of relatively sonolucent space outside of the cardiac structures. The location, size, mobility, and consistency of the pericardial space determined by echocardiography are considered to be reliable markers for defining pericardial processes. In certain clinical scenarios, however, it may be difficult to differentiate fluid from other pericardial processes, notably subepicardial adipose tissue. This case of a 76-year-old woman, who presented with possible cardiac tamponade after permanent pacemaker implantation, demonstrates some of the potential pitfalls in the diagnosis of pericardial space abnormalities.
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Affiliation(s)
- J T Kuvin
- Cardiovascular Imaging and Hemodynamics Laboratory, Tufts-New England Medical Center, Boston, Mass 02111, USA.
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Better N, Janicek MJ, Annese ML, Kaplan WD. Mediastinal tumor presenting as a cardiac halo on equilibrium radionuclide angiography. A differential diagnosis to pericardial effusion. Clin Nucl Med 1996; 21:334-5. [PMID: 8925627 DOI: 10.1097/00003072-199604000-00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- N Better
- Division of Nuclear Medicine, Dana Faber Cancer Institute, Boston, MA 02115, USA
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Miller SW. Imaging Pericardial Disease. Radiol Clin North Am 1989. [DOI: 10.1016/s0033-8389(22)01201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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ACQUATELLA HARRY. Echocardiographic Evaluation of the Spectrum of Pericardial Diseases: An Overview. Echocardiography 1989. [DOI: 10.1111/j.1540-8175.1989.tb00288.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Plehn J, Sager J, Foster E, Pirzada F, Schick E. Pericardial pseudotumor. Echocardiographic observation of juxtacardiac pulmonary collapse. Chest 1988; 94:837-41. [PMID: 3168578 DOI: 10.1378/chest.94.4.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Despite its value in the diagnosis of pericardial disease, two-dimensional echocardiography also is known to produce confounding results. Ten patients had juxtacardiac masses simulating pericardial tumor implants on echocardiographic examination ("pericardial pseudotumor") caused by juxtacardiac pulmonary atelectasis or lobar collapse. The atelectatic nature of these masses was based on echocardiographic delineation of pericardial and pleural anatomy, combined with ancillary radiographic and CT studies. Drainage of pleural fluid also led to disappearance of the masses on echocardiographic examination, suggesting that the masses were an ultrasonic manifestation of pulmonary atelectasis resulting from surrounding compressive effusive fluid. Finally, clinical follow-up failed to show development of malignant disease in any patient. The possibility of pericardial pseudotumor should be considered when ultrasound studies show juxtacardiac masses within large collections of pleural fluid, especially in the clinical absence of malignant disease.
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Affiliation(s)
- J Plehn
- Department of Cardiology, Thorndike Memorial Laboratory, Boston City Hospital 02118
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Yousem D, Traill TT, Wheeler PS, Fishman EK. Illustrative cases in pericardial effusion misdetection: correlation of echocardiography and CT. Cardiovasc Intervent Radiol 1987; 10:162-7. [PMID: 3111699 DOI: 10.1007/bf02577994] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eight equivocal two-dimensional echocardiograms with concurrent CT scans were evaluated to identify potential pitfalls in pericardial effusion detection. By echocardiography, two pleural effusions were felt to be pericardial, two hemopericardiums were interpreted as normal myocardium, three loculated pericardial effusions were not seen or were misinterpreted as other mediastinal collections, and one epicardial lipoma was called a pericardial effusion. When the clinical suspicion for pericardial effusion does not correlate with echocardiographic findings, CT scanning may be the definitive arbiter of pericardial disease.
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Abstract
The findings of small anterior and posterior relatively echo-free spaces adjacent to the epimyocardium by echocardiography is more often indicative of pseudopericardial effusion due to subepicardial fat deposition rather than true pericardial effusion (PE), at least in older obese and Type II diabetic patients. This conclusion was based on the echo and computed tomography (CT) correlation performed in 10 consecutive patients (8 women, 2 men). The mimicry of various extracardiac and cardiac causes resulting in confusion with anterior and posterior PE is emphasized. Subepicardial fat deposition is one of the most common causes which mimic presence of small PE on echo and can be confirmed easily by limited CT of the chest. Age, sex, obesity, and diabetes mellitus (Type II) appear to be the most common predisposing factors for the accumulation of excess subepicardial fat.
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ALPERT MARTINA, KELLY DIANAL. Value and Limitations of Echocardiography in the Assessment of Obese Patients. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00203.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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KURKJIAN KAREN, NABER STEPHENP, McINERNEY KEVINP, CALDEIRA MARJORYE, ISNER JEFFREYM, PANDIAN NATESAG. ECHO-PATHOLOGICAL CORRELATIONS FROM TUFTS: Echocardiographic Evaluation of Metastatic Pericardial Disease. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00204.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Galve E, Garcia-Del-Castillo H, Evangelista A, Batlle J, Permanyer-Miralda G, Soler-Soler J. Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance. Circulation 1986; 73:294-9. [PMID: 3943164 DOI: 10.1161/01.cir.73.2.294] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Incidence and significance of pericardial effusion in patients with acute myocardial infarction (AMI) have not been established. To evaluate these issues, we studied prospectively 138 consecutive patients with AMI. An echocardiogram was obtained in each 1, 3, and 10 days and 3 and 6 months after admission. Fifty four patients with unstable angina and 57 without heart disease were studied as controls. Echocardiographic diagnostic criteria of pericardial effusion were established from 33 additional patients undergoing surgery. Pericardial effusion was found in 28% of patients with AMI. Twenty-five percent of patients with AMI had pericardial effusion on the third day, vs 8% of patients with unstable angina (p less than .02) and 5% of patients without heart disease (p less than .01). At 1, 3, and 10 days and 3 and 6 months prevalence of pericardial effusion was 17%, 25%, 21%, 11%, and 8%, respectively. There was no case of tamponade. Pericardial effusion was more common in anterior AMI (p less than .02) and in patients with heart failure (p less than .05) but it was not significantly associated with early pericarditis, peak creatine kinase-MB, the level of anticoagulation, or mortality. Thus, pericardial effusion is a common event in patients with AMI (incidence of 28%), but does not result in specific complications. The reabsorption rate of pericardial effusion is slow and, in our experience, mild or moderate pericardial effusion does not preclude heparin therapy.
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