Images for pericardial

effusion
Abazie Ugochi
Early diastolic parasternal short axis 2D
echocardiogram showing LV inversion (arrow). PE,
pericardial effusion. The dynamic nature of this
finding is better appreciated in Video 3.
. 3. Parasternal long and short axis 2D images of a
medium asymptomatic pericardial effusion without
signs of cardiac tamponade. The size of the effusion
and lack of 2D and Doppler abnormalities indicate that
it has accumulated slowly enough that the parietal
pericardium added additional cells (stretched) so that
intrapericardial pressure is normal. Eff, pericardial
effusion.
Collapse
Early systolic subcostal 4-chamber
2Dechocardiogram showing right atrial inversion
(arrow). PE, pericardial effusion. The dynamic
nature of this finding is better appreciated in
Video 1 in which there is also RV inversion. LA,
left atrium; LV, left ventricle; PE, pericardial
effusion; RA, right atrium; RV, right ventricle.
ig. 7. Diastolic parasternal longaxis 2D
echocardiogram showing RV inversion (arrow). Ao,
aorta; PE, pericardial effusion. The dynamic nature of
this finding is better appreciated in Video 2 in which
there is also LA inversion.
 Pericardiocentesis
performing a pericardiocentesis, including the classically
taught blind subxiphoid approach, which is associated with
high rates of morbidity and mortality.
Most of these guided techniques involve in-plane
visualization of the needle in either a subxiphoid, apical,
or parasternal approach.

subxiphoid approach has a higher risk of injury to the

liver, heart, and IVC, with complication rates up to 20%
The apical approach involves locating the cardiac apex

inserting the needle 1 cm lateral to the apex, with the

point directed toward the effusion and in-line with the
ultrasound probe

taking care to avoid the lingula.

 medial-to-lateral parasternal approaches may have
minimal complications. However, when employing this
approach, care must be taken to avoid the internal
mammary artery, which can be identified using color-
flow Doppler echocardiology.6