Introduction of chest radiology: Part 2

(BQ) Continued part 1, part 2 of the document Introduction of chest radiology has contents: Miscellaneous cluster, positron e mission tomography computed tomography, diverse conditions, pediatric chest, esophagus, mediastinum, heart, and other contents. Invite you to refer. | Introduction of chest radiology: Part 2 chapter 8 Heart Roshan Lodha Pericardial Effusion Pericardial sac normally contains 15 to 50 ml of pericardial fluid. Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Excessive fluid accumulation leads to increased intrapericardial pressure and when this is enough pressure to adversely affect heart function, it is called cardiac tamponade. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of pericardial fluid, or from a structural abnormality that allows fluid to enter the pericardial cavity. Types of pericardial effusion are: a. Transudative (congestive heart failure, myxoedema, neph­rotic syndrome). b. Exudative (tuberculosis, spread from empyema) c. Hemorrhagic (trauma, rupture of aneurysms, malignant effusion). d. Malignant (due to fluid accumulation caused by metastasis) Causes of pericardial effusion are: a. Idiopathic b. Inflammatory i. Postmyocardial infarction (Dressler’s syndrome) ii. Connective tissue disorders Heart 101 c. Infectious i. Viral ii. Bacterial iii. Tuberculosis d. Postsurgical/trauma e. Radiotherapy f. Malignancy i. Primary, . pericardial mesothelioma ii. Metastatic g. Metabolic i. Hypothyroidism Patient presents with chest pain, breathlessness, dyspnea on exertion. A small effusion may be asymptomatic. On chest X-ray very small pericardial effusion may not be evident but when large enough it presents like “water-bottle heart” (Fig. ) in which the cardiopericardial silhouette is enlarged and assumes the shape of a water bottle or flask clinically it can produce dullness to percussion called Ewart’s sign. Fig.   Heart appears as a glob- ular enlargement giving a water bottle configuration 102 Chest Radiology Lateral chest X-ray may show an “Oreo Cookie Sign”: a vertical lucent line directly behind sternum (epicardial fat), behind .