Patients with<unk>  may have unremarkable physical exams but often present with tachycardia, distant heart sounds and tachypnea. A physical finding specific to<unk>  is dullness to percussion, bronchial breath sounds and egophony over the inferior angle of the left scapula. This phenomenon is known as Ewart's sign and is due to compression of the left lung base. Patients with concern for cardiac tamponade may present with abnormal vitals and what's classically known as the Beck's triad, which consists of hypotension (low blood pressure), jugular venous distension and distant heart sounds. Though these are the classical findings; all three occur simultaneously in only a minority of patients. Patients presenting with cardiac tamponade may also be evaluated for pulsus paradoxus. Pulsus paradoxus is a phenomenon in which systolic blood pressure drops by 10 mmHg or more during inspiration. In cardiac tamponade, the pressure within the pericardium is significantly higher, hence decreasing the compliance of the chambers (the capacity to expand/ conform to volume changes). During inspiration, right ventricle filling in increased, which causes the Interventricular septum to bulge into the left ventricle, hence leading to reduced left ventricular filling and consequently reduced stroke volume and low systolic blood pressure. Exams Chest X-ray showing a massive<unk> : Water bottle sign EKG: sinus tachycardia with low QRS voltage and electrical alternans Some patients with<unk> s may present with no symptoms and the diagnosis can be an incidental finding due to imaging of other illnesses. Patients who present with dyspnea or chest pain have a broad differential diagnosis and it may be necessary to rule out other causes like myocardial infarction, pulmonary embolism, pneumothorax, acute pericarditis, pneumonia, and esophageal rupture. Initial tests include electrocardiography (ECG) and chest x-ray. Chest x-ray: is non-specific and may not help identify a<unk>  but a very large, chronic<unk>  can present as "water-bottle sign" on an x-ray, which occurs when the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle. Chest radiograph is also helpful in ruling out pneumothorax, pneumonia, and esophageal rupture. ECG: may present with sinus tachycardia, low voltage QRS as well as electrical alternans. Due to the fluid accumulation around the heart, the heart is further away from the chest leads, which leads to the low voltage QRS. Electrical alternans signifies the up-and-down change of the QRS amplitude with every beat due to the heart swinging in the fluid (as displayed in the ultrasound image in the introduction) . These three findings together should raise suspicion for impending hemodynamic instability associated with cardiac tamponade. Echocardiogram (ultrasound): when<unk>  is suspected, echocardiography usually confirms the diagnosis and allows assessment of the size, location and signs of hemodynamic instability. A transthoracic echocardiogram (TTE) is usually sufficient to evaluate<unk>  and it may also help distinguish<unk>  from pleural<unk>  and MI. Most<unk> s appear as an anechoic area (black or without an echo) between the visceral and the parietal membrane. Complex or malignant<unk> s are more heterogeneous in appearance, meaning they may have variations in echo on ultrasound. TTE can also differentiate<unk>  based on the size. Although it's difficult to define size classifications because they vary with institutions, most commonly they are as follows: small 20. An echocardiogram is urgently needed for evaluation when there is concern for hemodynamic compromise, a rapidly developing<unk>  or history of recent cardiac surgery/procedures. Cardiac CT and MRI scans: cross-sectional imaging with computed tomography (CT) can help localize and quantify the<unk> , especially in a loculated<unk>  (a<unk>  contained to one area). CT imaging also helps assess for<unk>  pathology<unk>  thickening, constrictive pericarditis, malignancy-associated pericarditis). Whereas cardiac MRI is reserved for patients with poor echocardiogram findings and for assessing<unk>  inflammation, especially for patients with continued inflammation despite treatment. CT and MRI imaging can also be used for continued follow up on patients. Pericardiocentesis: is a procedure in which fluid is aspirated from the<unk>  cavity with a needle and catheter. This procedure can be used to analyze the fluid but more importantly can also provide symptomatic relief, especially in patients with hemodynamic compromise. Pericardiocentesis is usually guided by an echocardiogram to determine the exact location of the<unk>  and the optimal location of puncture site to minimize risk of complications. After the procedure, the aspirated fluid is analyzed for gross appearance (color, consistency, bloody), cell count, and concentration of glucose, protein, and other cellular components (for example lactate dehydrogenase). Fluid may be also sent for gram stain, acid fast stain, or culture if high suspicion of infectious cause. Bloody fluids may also be evaluated for malignant cells. Fluid analysis may result in: * transudative<unk> : due to non-inflammatory causes (congestive heart failure , myxoedema , nephrotic syndrome ) * exudative<unk> : inflammatory or malignant causes (tuberculosis , spread from empyema , metastasis) * hemorrhagic<unk> : high blood concentration (trauma, rupture of aneurysms, malignant<unk>  File:PericaridaleffusionCT.A CT scan showing a<unk>  File:Hemorragic<unk> .A large anechoic (black)<unk>  as seen on ultrasound. Closed arrow: the heart, open arrow: the<unk>  File:Tamponade.Pericardial<unk>  due to malignancy. Note bulbous heart and primary lung cancer in right upper lobe. File:Pericardiocentesis.Pericardiocentesis: fluid aspiration of hemorrhagic<unk>
Pericardial effusion
Pericarditis
Cardiac tamponade
Subpulmonic effusion
Acute pericarditis
Pleural effusion
Constrictive pericarditis
Pneumopericardium