This document discusses pericardial effusion and includes 6 figures showing examples on medical imaging. Figure 1 shows pericardial effusion and pleural effusions from coxsackievirus infection. Figure 2 demonstrates a large pericardial effusion 3 weeks after a myocardial infarction. Figure 3 shows globular cardiac enlargement in a child on long-term hemodialysis. Figure 4 compares the normal pericardium to the pathognomonic "epicardial fat pad sign" seen with pericardial effusion. Figures 5 and 6 demonstrate pericardial effusions on CT and MRI scans, with the effusions appearing as low-density areas separated from the heart.

1. 20Pericardial Effusion

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig CA 20-1 Infectious pericarditis. Globular enlargement of
the cardiac silhouette reflects a combination of pericarditis
and pericardial effusion in a patient with coxsackievirus
infection. There are small pleural effusions bilaterally.

4. • Fig CA 20-2 Dressler's syndrome. Chest film obtained 3 weeks after
an acute myocardial infarction demonstrates a large pericardial
effusion appearing as a rapid increase in heart size in comparison
with an essentially normal-sized heart 1 week earlier.

5. Fig CA 20-3 Uremia. Globular enlargement of the cardiac
silhouette in a child on prolonged hemodialysis.

6. • Fig CA 20-4 Epicardial fat pad sign in pericardial
effusion. (A) In a normal person, a thin, relatively
dense line (arrow) representing the normal
pericardium lies between the anterior
mediastinal and subepicardial fat. (B) Lateral
chest radiograph demonstrates a wide soft-tissue
density separating the subepicardial fat stripe
(arrows) from the anterior mediastinal fat. This is
a virtually pathognomonic sign of pericardial
effusion or thickening.

7. • Fig CA 20-5 Pericardial effusion. CT scan made after the injection of
intravenous contrast material shows the pericardial effusion as a
low-density area (arrowheads) that is clearly demarcated from the
contrast-enhanced blood in the intracardiac chambers and
descending aorta. Note the bilateral pleural effusions posteriorly.
(DA, descending aorta; LV, left ventricle; RA, right atrium; RV, right
ventricle.)13

8. • Fig CA 20-6 Pericardial effusion. MRI scan shows
the pericardium (arrows) to be displaced away
from the heart by a huge pericardial effusion that
has very little signal intensity. The effect of gravity
is seen in the posterior location of both the
pericardial and the right pleural effusions.14