Challenges in imaging complex pericardial effusions: Incremental value of multimodality imaging
Bernardo M, Jafri S, and Ananthasubramaniam K. Challenges in imaging complex pericardial effusions: Incremental value of multimodality imaging. Journal of the American College of Cardiology 2020; 75(11):3395.
J Am Coll Cardiol
Background Pericardial effusion can be a common finding, but loculated fluid collections may be missed and require more of a focused examination with complementary imaging studies. Case A 60 years old female with metastatic lung cancer was sent to the emergency room after chest CT completed by her oncologist showed a large (15 × 9 × 7 cm) ring-enhancing lesion causing mass effect to the heart and left lung. She denied complaints of chest pain, palpitations, dyspnea, or syncope. An echocardiogram was completed to further ascertain anatomic delineation and tissue characterization of this lesion. Decision-making In this case, chest CT provides advantages of better evaluating pericardial thickness, extracardiac anatomy and possible tissue content. On the other hand, echocardiography avoids radiation and contrast exposure, can be completed at bedside in critical patients, and shows dynamic information of intracardiac structures. Together, they helped to confirm diagnosis of a loculated pericardial effusion likely due to malignancy in this patient. Conclusion Multimodality imaging is integral for correct diagnosis and appropriate management of cardiovascular conditions, especially that of pericardial diseases. Initial imaging may fail to provide adequate information on anatomic origin of masses or fluid collection. Therefore, pericardial effusion especially loculated effusions, may be misconstrued as pericardial tumors or cysts, extracardiac complex masses, or loculated pleural effusions.