Pericardial Effusion – Tamponade

Facts Pericardial fluid collections can be visualized in all standard cardiac views. Look for an anechoic (black) border surrounding the heart, which indicates the presence of fluid. Compression of the right ventricle during diastole is a critical sign of tamponade, signaling increasing pressure on the heart. Hemodynamic instability may develop as the effusion increases, with possible signs of tamponade requiring prompt intervention. Signs of cardiac tamponade is: Diastolic collapse of Right atrium (RA)/ right ventricle (RV) Enlarged fixed IVC Small LV cavity Swinging heart

Tips A pericardial fluid collection large enough to cause hemodynamic instability is often visible in the subcostal view, appearing between the liver and the right side of the heart closest to the transducer. Monitoring for right ventricular compression and progression to tamponade is essential, particularly in patients with clinical instability. Immediate drainage may be necessary if tamponade is identified.

Below is a collection of ultrasound clips showing pericardial effusion and signs of tamponade:

These clips demonstrate various findings, from moderate effusion with preserved cardiac function to severe tamponade requiring immediate drainage. The presence of pericardial effusion and its effect on right and left ventricular filling are key to diagnosing and managing these cases.