Can Pleural Effusions Cause Cardiac Tamponade?

Alam, Hasan B.; Levitt, Adam; Molyneaux, Robert; Davidson, Paul C.; Sample, George A.

doi:10.1378/chest.116.6.1820

Cited by 32 publications

(25 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with large pleural effusions have been reported to show signs of impending cardiac tamponade with diastolic collapse of the right ventricle and worsening clinical symptoms [1][2][3]. Echocardiographic diastolic collapse of the right ventricle is considered the most sensitive and specific sign of cardiac tamponade [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency department diagnosis of massive pleural effusion causing right ventricular diastolic collapse using bedside ultrasonography

2010

View full text Add to dashboard Cite

Introduction A 75-year-old man with a 150-pack-year smoking history presented to the emergency department with progressively worsening shortness of breath, dyspnea on exertion, cough with white sputum and right-sided chest pain with right shoulder radiation for 1 week. Chest X-ray and bedside ultrasonography revealed a massive pleural effusion. Bedside subcostal ultrasound examination of the heart showed diastolic collapse of the right ventricle, a tamponade-like picture, that corrected after thoracentesis and pleural fluid removal. Conclusion Bedside emergency department ultrasonography was used to assist in the diagnosis of massive pleural effusion causing right ventricular diastolic collapse.Keywords Ultrasound Á Massive pleural effusion Á Right ventricle diastolic collapse Case reportA 75-year-old man with a 150-pack-year smoking history presented to the emergency department with progressively worsening shortness of breath, dyspnea on exertion, cough with white sputum and right-sided chest pain with right shoulder radiation for 1 week. He also complained of losing 15 lb over the past few months. His ED vital signs were temperature 97.5°F, blood pressure 150/94 mmHg, respiratory rate 20 bpm, room air oxygen saturation 96%. Electrocardiogram revealed normal sinus rhythm with a heart rate of 111 bpm. His physical examination was notable for a thin man with decreased breath sounds on the right side and no leg edema or tenderness to palpation. Portable chest X-ray showed an extensive right pleural effusion. Initial laboratory studies were normal.An initial ED bedside ultrasound was performed of the chest and heart (see Video Clips S1, S2 and S3 available as supporting information in the online version of this paper). Examination of the right chest with both low frequency curved array and high frequency M-mode sonography revealed a massive pleural effusion with collapsed lung (Figs. 1, 2, 3). Subcostal bedside ultrasound examination of the heart showed diastolic collapse of the right ventricle with minimal pericardial effusion (Fig. 4). Subcostal evaluation of the inferior vena cava revealed marked inspiratory collapse (Fig. 5). Emergency department right chest thoracentesis was performed given the cardiac subcostal ultrasound findings of impending cardiac tamponade with diastolic collapse of the right ventricle, coupled with the patient becoming progressively more short of breath in the ED. The patient immediately felt better and less short of breath, with a decreased heart rate of 91 bpm, after the removal of 1.75 l of straw colored fluid. The fluid was a non-infectious exudate with a pH of 7.29. Repeat postthoracentesis ED bedside subcostal sonography revealed normal right ventricular filling with no diastolic collapse of the right ventricle ( Fig. 6 and see Video Clips S4 and S5 available as supporting information in the online version of this paper). The patient showed signs of improved hemodynamics as subcostal evaluation of the inferior vena cava Electronic supplementary material The online version of this a...

show abstract

Section: Discussionmentioning

confidence: 99%

“…Echocardiographic diastolic collapse of the right ventricle is considered the most sensitive and specific sign of cardiac tamponade [1][2][3][4]. Patients with a large pleural effusion and right ventricular diastolic collapse may not have hemodynamic compromise; however, early ED thoracentesis can improve patients' symptoms [4].…”

Section: Discussionmentioning

confidence: 99%

Emergency department diagnosis of massive pleural effusion causing right ventricular diastolic collapse using bedside ultrasonography

2010

View full text Add to dashboard Cite

show abstract

“…Pleural effusion has also been described as a cause of tamponade [6]. A posterior percutaneous approach allows a successful pleuro-pericardiocentesis procedure [27].…”

Section: Ultrasound-guided Pericardial Drainagementioning

confidence: 99%

“…Extrapericardial tamponade has rarely been reported and may be caused by pleural effusions [6] or a dilated retrosternal gastric roll [7], when elevated pressures are transmitted to the pericardial space, resulting in impaired cardiac filling and a tamponade like physiology ( Fig. 2a and b).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous treatment in patients presenting with malignant cardiac tamponade

2005

View full text Add to dashboard Cite

The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment.

show abstract

“…There are, however, other conditions in which some of these findings are not present. Even though pulsus paradoxus is most frequently described in association with cardiac tamponade, it may occur in patients without tamponade as a result of acute or chronic obstructive airway disease [9], pulmonary embolism, tension pneumothorax, large pleural effusions [10], effusive constrictive pericarditis, right ventricular infarction, restrictive cardiomyopathy, extreme obesity, or tense ascites. Conversely, pulsus paradoxus may be absent during tamponade because of atrial septal defect, severe aortic stenosis, left ventricular dysfunction, or simply decreased intravascular volume (low pressure tamponade) [11,12].…”

Section: Clinical Diagnosis Of Cardiac Tamponadementioning

confidence: 99%

Diagnostic Value of Echocardiography in Cardiac Tamponade

Tsang

Oh²,

Seward³

et al. 2000

Herz

View full text Add to dashboard Cite

Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, and hypotension are important clues to the diagnosis, but are non-specific. Echocardiography allows rapid confirmation of the presence or absence of an effusion, and enables assessment of its hemodynamic impact. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiographically-guided pericardiocentesis with catheter drainage is the primary treatment strategy of choice for most large or hemodynamically significant effusions. In contemporary clinical practice, echocardiography is the gold standard for diagnosis of tamponade and is essential for directing treatment.

show abstract

Can Pleural Effusions Cause Cardiac Tamponade?

Cited by 32 publications

References 5 publications

Emergency department diagnosis of massive pleural effusion causing right ventricular diastolic collapse using bedside ultrasonography

Emergency department diagnosis of massive pleural effusion causing right ventricular diastolic collapse using bedside ultrasonography

Percutaneous treatment in patients presenting with malignant cardiac tamponade

Diagnostic Value of Echocardiography in Cardiac Tamponade

Contact Info

Product

Resources

About