Images Dr Juan Chiang An 85 year old man is brought in by ambulance after a syncopal event. He was hypotensive on scene, BP 78/50. He is given fluid by the paramedics but remains hypotensive. He has no chest pain and is not short of breath. On arrival at the Emergency Department, he is alert, Read more about Dissection[…]
Ultrasound images and text Genevieve Carbonatto A 53 year old lady presents to the Emergency Department after having stabbed herself in the chest in a suicide attempt. The knife is still in the chest close to and to the left of the sternum in the 5th intercostal space. She is alert and orientated, she says Read more about Trauma : knife through chest[…]
Images : Sarah Vaughan, text Genevieve Carbonatto A 56 year old man presents to the Emergency department short of breath and unwell. He gives a history of 2 hours of shortness of breath and chest pain. He has been recently diagnosed with metastatic adenocarcinoma. These are his vital signs He is hypotensive, his BP arterial Read more about Pericardial Tamponade[…]
Text and images Genevieve Carbonatto Pericardial effusions are commonplace. A pericardial effusion is not synonomous with pericardial tamponade. Pericardial tamponade is a medical emergency characterised by shock and associated with a number of clinical criteria including Becks triad (hypotension, decreased heart sounds, elevated JVP) pulsus paradoxus ( > 12 mmHg drop in BP on inspiration), Read more about Assessment of Pericardial effusion[…]
Images by Genevieve Carbonatto Parasternal long axis, (PLAX) left ventricle showing a small circumferential pericardial effusion ending anteriorly to the descending thoracic aorta, (D.Th.A.). The D.Th.A. is the anatomical landmark to differentiate between a pericardial and a pleural effusion. The pericardial effusion is trivial anterior to the RV anterior wall. There is also a suggestion of Read more about Pericardial effusion and pleural effusion[…]
Images by Genevieve Carbonatto Frozen image of the apical 4-chamber view showing a moderate circumferential pericardial effusion containing fibrinous strands shown by the solid white arrow. There are strands throughout the effusion. Parasternal long axis (PLAX) Left ventricle showing a moderate circumferential pericardial effusion. Apical 4-chamber view showing a moderate circumferential pericardial effusion containing fibrinous strands. Read more about Pericardial effusion with fibrinous strands[…]
Images by Genevieve Carbonatto 5 chamber view shows large pericardial effusion and right ventricular wall and right atrial wall collapse Parasternal long axis left ventricle showing a circumferential pericardial effusion. It is small anteriorly but moderate posteriorly. Parasternal short axis left ventricle at the level of the papillary muscles with a large circumferential pericardial effusion. Parasternal Read more about Large pericardial effusion[…]
Images by Genevieve Carbonatto Large circumferential pericardial effusion, best seen on moving clips Parasternal long axis of the left ventricle demonstrating a moderate circumferential pericardial effusion. No echo evidence of cardiac tamponade on this view. RV contracts in systole and relaxes in diastole, no collapse evident. Apical 4-chamber demonstrating circumferential pericardial effusion. No definite echo signs Read more about Pericardial Effusion[…]
Images by Genevieve Carbonatto Parasternal Long axis (PLAX) of the left ventricle demonstrating a large circumferential pericardial effusion, (passes anterior to the descending thoracic aorta). Note the RV anterior wall appears as though it may be collapsing in early diastole when RV pressure is at its lowest. Has the appearance of someone jumping on a trampoline. Read more about Pericardial effusion and metastasis[…]
Images by Genevieve Carbonatto PLAX view. Very large pericardial effusion. Heart “swinging” in fluid Size should be measured at the end of diastole. To be accurate this should be done using the ECG for timing. Practically speaking the exact size of the effusion is not important. This effusion is circumferential and is over 2cm in Read more about Large pericardial effusion[…]