Question 4: Pericardial effusion/PE/Sepsis

Question 4. 
Describe abnormalities that you could expect to see on a focused ultrasound scan of a heart in

  • Pericardial Effusion
  • PE
  • Sepsis

Percardial effusion
• Echofree space if effusion anechoic within pericardial space. Effusion may be echoic if it is blood or pus
• Effusion may be circumferential or loculated
• Effusion may have haemodynamic effects : RA wall collapse at the end of systole or early diastole, RV free wall collapse in diastole, LA or LV collapse – rarely, IVC fixed and dilated

• Large RV (more than 2/3 of the LV in the 4 chamber view, more than the size of the aorta or LA in the PLAX view)
• D shaped LV
• Small LV compared to RV
• +ve M Connels’ sign
• Septal bouncing
• Fixed and dilated IVC
• Reduced TAPSE (less than than 1.0 cm – normal 1.5 to 2.0 cm)

• Hyperdynamic heart
• “kissing walls of left ventricle”
• RV normal size and function
• Small and collapsing IVC (less than 1.00 cm collapsing > 50%)

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