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Pericardial effusion

A pericardial effusion is characterised by build up of fluid in the pericardial space (a normal pericardiac sac contains approximately 30 - 50 mls of fluid).

* idiopathic
* inflammatory
  •  post myocardial infarction (Dressler syndrome)
  •  connective tissue disorders
* infectious
  •  viral
  •  bacterial
  •  tuberculosis
* post surgical / trauma
* radiotherapy
* malignancy
  •  primary : e.g pericardial mesothelioma
  •  metastatic
* metabolic
  •  hypothyroidism
Radiographic features in Plain film (CXR)
* a very small pericardial effusion can be occult on plain film
* there can be globular enlargement of the cardiac shadow giving a "water bottle" configuration.
* lateral CXR may show an "Oreo Cookie Sign" : a vertical lucent line directly behind sternum (epicardial fat), behind this a vertical opaque line (pericardial fluid) and behind this a vertical lucent line (pericardial fat).
* widening of the subcarinal angle without other evidence of left atrial enlargement may be an indirect clue.