The echocardiogram from this patient demonstrates a moderate size pericardial effusion, as evidenced by the echo-free fluid space surrounding the heart behind the left ventricle and in front of the right ventricle.
The left atrium and the mitral and aortic valves are well seen.
In the real-time study that follows, note the undulating motion of the right ventricular free wall due to the presence of fluid anteriorly. A moderate pericardial effusion, defined as 500-1000 cc., has an echo-free space both posteriorly and anteriorly. The morphology and motion of the mitral and aortic valve leaflets are normal. The left ventricular cavity size and contractility are also normal.
Another patient's short axis
This is a diastolic still-frame of a two-dimensional parasternal short axis view of the left ventricle at the level of the papillary muscles that also shows the echo-free space surrounding the heart, consistent with a moderate-sized pericardial effusion.
The effusion is filled with fibrinous strands that are attached to the pericardium. These strands are located between the visceral and parietal pericardium.
In the real-time study that follows, note the undulating motion of the fibrinous strands within the moderate-sized pericardial effusion. The left ventricular cavity size and contractility are normal.
Tamponade short axis
This is a still-frame of a 2-dimensional echocardiogram in parasternal short axis view at the level of the papillary muscles from another patient who had clinical evidence of cardiac tamponade. There is a large pericardial effusion that completely surrounds the heart. The cavity sizes of the left and right ventricles are reduced.
In the real-time study that follows, note how the heart swings in the large fluid-filled pericardial space, shifting in position from systole to diastole. Cardiac motion is frequently excessive in patients with large effusions. The striking cardiac movement throughout the cardiac cycle correlates with the ECG evidence of electrical alternans. Note the collapsing inward motion of the right ventricular free wall during diastole. Early diastolic collapse of the right ventricular free wall and right atrial free wall in late diastole are consistent with cardiac tamponade.
Constrictive pericarditis 4-chamber view
This is a diastolic still-frame of an apical four-chamber view from a patient with constrictive pericarditis.
The interventricular septum, left atrium, right atrium and the mitral and tricuspid valves are identified.
In the real-time study that follows, note the rapid to-and-fro changes in the curvature of the interventricular septum resulting from the heart being encased in a rigid pericardial covering. The septum first appears to contract with the right ventricle and then with the left ventricle, changing the relative right and left ventricular cavity sizes with each respiratory cycle. This motion gives the septum the appearance that it is bouncing and reflects the respiratory changes in right and left ventricular stroke volume, the presumed cause of pulsus paradoxus.