Clinical Information Pericardial Effusion

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Clinical InformationPericardial Effusion
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Loculated Pericardial Effusion
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Simple Pericardial Effusion (0 HU)
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Serosanguineous Pericardial Effusion (35 HU)
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Cine GRE Non-hemorrhagic Effusion
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EKG-Gated T1 SE Hemorrhagic Effusion
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DiagnosisPericardial Effusion
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PERICARDIAL EFFUSION

• Obstruction of venous or lymphatic drainage from
  the heart
• Greater than 50 mL fluid in pericardial space
• Causes
• Heart failure
• Renal insufficiency
• Infection (bacterial, viral, TB)
• Neoplasia (lung, breast, lymphoma)
• Trauma
• MI
• Myxedema (hypothyroidism)

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INDICATIONS FOR CT/MRI

• Suspected loculated effusion
• Suspected hemorrhagic effusion
• Suspected pericardial thickening
• Inconclusive echo
• Limitations of Echo small loculated effusion,
  hematoma, cysts, tumors, hernias, lipodystrophia,
  left pleural effusion, mitral annular
  calcification, giant left atrium, epicardial fat,
  inferior left pulmonary vein, LV pseudoaneurysm

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CT ATTENUATION

• Close to water ? likely simple effusion
• Increased density ? malignancy, blood, pus,
  myxedema
• Low density ? chylopericardium

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MRI

• Non-hemorrhagic fluid low T1, high T2/GRE cine
• Hemorrhagic fluid high T1, low T2/GRE cine
• Irregular thickening/nodularity ? think malignancy