Pericarditis echocardiography


 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
The role of echocardiography in the evaluation of the patient with pericarditis is to chracterize the presence, size, location and hemodynamic impact of a pericardial effusion.

Advantages of Other Imaging Modalities

 * Pericardial CT is the optimal technology to assess perciardial calcification

Pericardial effusion secondary to pericarditis is seen on echocardiogram as a large hypoechoic region surrounding the heart. A swinging motion of the heart with each beat may also be noted in the setting of cardiac tamponade. It is this swinging motion that gives rise to electrical alternans. Echocardiography demonstrates the collection of pericardial fluid. The best view to visualize a pericardial effusion is the subcostal view. Signs of more advanced tamponade include indentation of the atrium and ventricle, and in later stages collapse of these structures. The location of the fluid should be characterized so that the feasability and safety of pericardiocentesis can be assessed. For example, the location of the fluid should be characterized as either circumferential, posterior or anterior. The cm of fluid thickness should be characterized. The presence of loculations should be described. Usually pericardiocentesis can be performed if there is over 0.5 cm of anterior fluid.

Pericardial effusion and cardiac tamponade
In pericardial effusion, large hypoechoic regions are seen surrounding the heart with presence of oscillatory motion of heart.

The echocardiogram below demonstrates swinging motion of the heart in cardiac tamponade. 

Echocardiography of heart with loculated pericardial effusion compressing the left ventricle. 

Cardiac tamponade 

Cardiac tamponade 

Left ventricular free wall rupture with cardiac tamponade 

Collapse of right ventricle in patient with cardiac tamponade 