Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Pericardial Disease

Abstract

We studied 19 patients with pericardial disease using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE a more comprehensive assessment of pericardial effusion can be made and both the parietal and visceral layers of the pericardium can be visualized en face and examined for pathologies and fibrin deposits. In our series of patients, 3DTTE was superior to 2DTTE in uncovering mass lesions involving the pericardium such as tuberculous granulomas and metastatic disease. Furthermore, it provided a better assessment of the nature of pericardial lesions, such as pericardial and mediastinal hematomas, pericardial cysts, and metastatic disease to the pericardium by sequential cropping of the 3D data sets and visualizing the interior of the lesions in a manner not possible with 2DTTE. It was also valuable in determining the extent of pericardial calcification in pericardial constriction and in measuring the size of pericardial masses. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of pericardial diseases and that it provides incremental knowledge to the echocardiographer.

Role of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in Pericardial Disease

“…The 3D modality has a better capacity to identify and assess the size of the echo reflectors that helps identify the hematomas (Fig. 4A and B), and purulent pericardial effusions more effectively 14 . The thin slices of 2DTTE images tend to underestimate the size of the floaters in comparison to 3D images as we reported in our case series report.…”

“…1). 14 Such a view at a high resolution enables one to view the smoothness of the pericardial surface, and any deposits either fibrinous or potentially malignant. One can also identify the fibrin strands individually and trace their course, consistency, and mobility (Figs.…”

“…Fibrinous bands can be mistaken for falciform ligament with 2DTTE because both appear as linear structures. However, with 3DTTE one can view the surface of the falciform ligament that appears as a sheet‐like structure and thus diagnose ascites with a higher level of confidence 14 . Similarly with the identification of the collapsed lung and its relationship to the heart, one can better differentiate pleural effusion from pericardial effusion 15…”

Incremental Value of Live/Real Time Three‐Dimensional Echocardiography in the Diagnosis and Evaluation of Pericardial Cyst

“…Apart from this, 3DTTE has the ability to view the smoothness of the pericardial surface and any deposits which can be fibrinous or potentially malignant. 3 Fibrin strands within the cyst can also be identified individually allowing physicians to trace their course, consistency, and mobility. 10 In our case, we were able to track the smoothness of the cyst by obtaining multiple pyramidal data sets to track the entire surface of the cyst.…”

Pericarditis: Pathophysiology, Diagnosis, and Management

“…It is also valuable in determining the extent of pericardial calcification in pericardial constriction and in measuring the size of pericardial masses [29].…”