Pericardial effusion

Case contributed by Dr Matthew Jarvis


Decreased conscious state, shock and hypoxia

Patient Data

Age: 50
Gender: Male

On frontal chest x-ray there is massive cardiomegaly with a water bottle sign appearance.


This CTPA study is negative for pulmonary embolus. There is a very large pericardial effusion with maximal thickness around the left ventricle and right atrium. There is evidence of right ventricular dilatation. There is underlying centrilobular emphysema and an area of consolidation in the posterior aspect of left lower lobe, atelectasis in right lower lobe. Evidence of pancreatic calcification.

Case Discussion

  • This patient was profoundly shocked and underwent urgent pericardiocentesis with over 2L of transudative fluid drained with resultant improvement in hemodynamics.
  • While almost certainly a chronic effusion, this patient had an acute decompensation with clinical and echocardiogram evidence of tamponade raising the likelihood of an acute component.
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Case information

rID: 44397
Published: 20th Apr 2016
Last edited: 14th Aug 2019
System: Chest, Cardiac
Tag: basic
Inclusion in quiz mode: Included

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