What is the role of echocardiography in the evaluation of cardiac tamponade?

Updated: Nov 28, 2018
  • Author: Chakri Yarlagadda, MD, FACC, FSCAI, FASNC, CCDS; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Although echocardiography provides useful information, cardiac tamponade is a clinical diagnosis. The following may be observed with 2-dimensional (2-D) echocardiography:

  • An echo-free space posterior and anterior to the left ventricle and behind the left atrium - After cardiac surgery, a localized, posterior fluid collection without significant anterior effusion may occur and may readily compromise cardiac output

  • Early diastolic collapse of the right ventricular free wall (see the images below)

    Early diastolic collapse of right ventricular free Early diastolic collapse of right ventricular free wall (subcostal view).
    Early diastolic collapse of right ventricular free Early diastolic collapse of right ventricular free wall (parasternal short-axis view at aortic valve).
  • Late diastolic compression/collapse of the right atrium (see the image below)

    Late diastolic collapse of right atrium (subcostal Late diastolic collapse of right atrium (subcostal view).
  • Swinging of the heart in the pericardial sac

  • LV pseudohypertrophy

  • Inferior vena cava plethora with minimal or no collapse with inspiration (see the image below)

    Dilated inferior vena cava. Dilated inferior vena cava.
  • A greater than 40% relative inspiratory augmentation of blood flow across the tricuspid valve

  • A greater than 25% relative decrease in inspiratory flow across the mitral valve


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