Sensitivity and Specificity of Echocardiographic Diagnosis of Pericardial Effusion

Abstract

In order to evaluate the reliability and sensitivity of echocardiograms for detecting and quantitating pericardial effusion, 41 patients had echocardiograms on the day prior to cardiac operation. A fluid trap was used to aspirate the pericardium at operation. Thirty-nine of 41 patients had echocardiograms of diagnostic quality. In 25 patients, the echocardiogram was negative for pericardial effusion, with 0-16 ml identified at operation. In 13 patients, the echocardiogram was positive for pericardial effusion, with 15-775 ml aspirated at operation. A transition of patterns of relative posterior epicardial-pericardial movement was noted as the pericardial fluid volume increased. More than 15 ml was always found when a posterior echo-free space persisted throughout the cardiac cycle between a flat pericardium relative to the epicardium. In the presence of such a posterior echo-free space, a large anterior echo-free space made a moderately large pericardial effusion likely. In the absence of this diagnostic posterior echo-free space, an anterior echo-free space had no diagnostic significance, as it was found in 11 patients with less than 16 ml of pericardial effusion. A small posterior echo-free space persisting throughout the cardiac cycle between pericardial and epicardial echoes demonstrating virtually identical movements was found in two patients without any surgical evidence for pericardial effusion, but with evidence of adhesive fibrocalcific pericardial disease. A method of estimating pericardial volume is proposed, which uses the difference between the cubed diameters at the end-diastole of the pericardium and epicardium.

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance.

“…The three observers were in agreement about the interpretation of the two-dimensional studies in all 21 cases in which doubts had been raised by the M mode echocardiogram or in which a pattern of effusion was persistent on the latter. Two-dimensional recordings confirmed that the M mode echo-free space corresponded to PE in 1 1, whereas in the remaining 10 this space could have been related to other adjacent structures.…”

“…(5) X-ray changes. For all patients at least three x-ray chest films were available, two of which were obtained within the 4 first days after admission and the third of which was obtained on day 10. All were examined looking for changes in heart size, findings suggesting heart failure, and signs of pleural effusion.…”

Association Between Serum C‐reactive Protein Elevation and Atrial Fibrillation After First Anterior Myocardial Infarction

“…Early and late diastolic, and peak systolic mitral annular velocities were recorded. Pericardial effusion was defined according to the method of Horowitz et al 15 An epicardial-pericardial separation that persisted throughout the cardiac cycle (D pattern) was considered diagnostic of pericardial effusion.…”

Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome.

“…Echocardiograms were not obtained routinely, but rather, as clinically indicated. The echocardiographic diagnosis of pericardial effusion was made using the criteria proposed by Horowitz et al 9 The usual uncomplicated hospital stay was 10-14 days. Monthly follow-up visits for all 1122 patients (87%) who lived in the area began 1 month after discharge during the first postoperative year and every 6 months thereafter.…”