“…Additionally, 3D structures such as the falciform ligament can be well seen and its attachments demarcated. This structure can have paramount importance in the differential diagnosis of paracardiac echo‐free spaces, where its identification in the echo‐free space denotes ascites rather than a pericardial effusion 30,31 . On 2DTTE, the falciform ligament appears as a thin, mobile structure which cannot be easily differentiated from fibrin strands seen in many patients with pericardial effusion.…”
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.
“…Additionally, 3D structures such as the falciform ligament can be well seen and its attachments demarcated. This structure can have paramount importance in the differential diagnosis of paracardiac echo‐free spaces, where its identification in the echo‐free space denotes ascites rather than a pericardial effusion 30,31 . On 2DTTE, the falciform ligament appears as a thin, mobile structure which cannot be easily differentiated from fibrin strands seen in many patients with pericardial effusion.…”
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.
“…In these cases, the falciform ligament is observed within the fluid, which in addition with the visible diaphragmatic movement, allows to confirm the diagnosis (Fig. 2a) [12]. Moreover, extending the examination to the rest of the abdomen will easily demonstrate the presence of ascites to complete the diagnosis.Fig.…”
BackgroundPoint-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside.ObjectivesThis article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them.DiscussionThe following aspects were selected and reviewed: pericardial effusion vs. pleural vs. ascites vs. epicardial fat; right ventricle dilation in acute pulmonary embolism and inferior vena cava for volume status assessment in cardiac ultrasound; lung point and lung pulse misinterpretations and mirror artifacts vs. lung consolidations in lung ultrasound; peritoneal fluid vs. the stomach and a critical appraisal of gallbladder signs of acute cholecystitis in abdominal ultrasound; the rouleaux phenomenon vs. deep vein thrombosis or acute right strain in vascular ultrasound.ConclusionsFollowing some rules in technique and interpretation, and always integrating POCUS findings into the broader clinical context, most POCUS misdiagnosis can be avoided, and thus patients’ safety can be enhanced. Being aware of a list of common pitfalls may help to avoid misdiagnoses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-016-0052-x) contains supplementary material, which is available to authorized users.
“…In one study, 32 consecutive patients with ascites were evaluated and in all 32 the FL was noted from a subcostal view 7 . Likewise, in our experience, when ascites is noted in a subcostal window, the FL will invariably be noted undulating within the ascitic fluid.…”
mentioning
confidence: 96%
“…Having a typical concave band‐like appearance (Figs. 2 and 3), the FL will usually undulate during real time imaging, due to transmitted heart motion with each cardiac cycle (Video Clips A and B) 5–8 …”
mentioning
confidence: 99%
“…As ascites may be confused with other fluid collections (pleural fluid, pericardial fluid, pericardial cyst), noting the FL within ascites helps one make the correct diagnosis 5–7 …”
falciform ligament, ascites, echocardiographyThe falciform ligament (FL: ligamentum falciforme hepatic) is a fold of peritoneum connecting the parietal peritoneum of the anterior abdominal wall with that of the visceral peritoneum over the anterior surface of the liver. The site of attachment to the anterior surface
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