1. Cardiac p36 (Pericardium)

Question 1

Pericardial effusion - definition

Answer 1

More than the normal 50ml fluid between pericardial layers.

Question 2

Pericardial anatomy (2)

Answer 2

2 layers (visceral and parietal).
Usually about 50ml fluid between.

Question 3

Pericardial effusion - causes (3)

Answer 3

Renal failure (uraemia),
Lupus,
Dressler syndrome

Question 4

Pericardial effusion - imaging (3)

Answer 4

CXR:
Increased cardiac size,
Giant water bottle heart,
Lateral CXR with 2 lucent lines (epicardial and pericardial fat) either side of the effusion (Oreo cookie sign)

Question 5

Cardiac tamponade - definition

Answer 5

Compromised filling of the chambers (atria first) due to increased pressure in the pericardium, due to effusion.

Question 6

Cardiac tamponade - cause (2)

Answer 6

Can occur with >100ml of fluid.
Rate of filling is key, slower filling gives myocardium time to stretch.

Question 7

Cardiac tamponade - imaging (2)

Answer 7

Flattening or inversion of IV septum due to augmented RV filling in inspiration.
Reflux of contrast into IVC and azygous system on CT

Question 8

Pericardial cyst - anatomy (3)

Answer 8

Benign.
Usually right pericardial sulcus.
Don’t communicate with pericardium.

Question 9

Pericardial cyst - imaging

Answer 9

Water density along with right cardiophrenic sulcus

Question 10

Congenital absence of pericardium - anatomy (3)

Answer 10

Can be total
More commonly partial, over the left atrium and adjacemtn pulmonary artery.
Heart shifts towards missing side.

Question 11

Congenital absence of pericardium - imaging

Answer 11

CT or MRI showing heart contacting left chest wall.

Question 12

Congenital absence of pericardium - trivia (2)

Answer 12

Cardiac herniation and volvulus can occur in pts who undergo partial pneumonectomy.
Left atrial appendage is most at risk of strangulation.