What is the role of two-dimensional echocardiography in the workup of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. Early effusions tend to accumulate posteriorly owing to expandable posterior/lateral pericardium.

Large effusions are characterized by excessive motion within the pericardial sac, also called swinging. Small effusions have an echo-free space of less than 10 mm and are generally seen posteriorly. Moderate-sized effusions range from 10-20 mm and are circumferential. An echo-free space of more than 20 mm indicates a large effusion. Fluid adjacent to the right atrium is an early sign of pericardial effusion. (See the image below.) [19]

This image is from a patient with malignant perica This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).

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