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Pericardial effusion in a dialysis patient: Things to observe on Focused Cardiac Ultrasound

Here are images from a dialysis patient with pericardial effusion demonstrating echocardiographic signs of tamponade. Please go through this post on Renal Fellow Network for detailed description.

  1. Hepatic vein Doppler: expiratory D-wave reversal
  2. Parasternal long axis showing diastolic right ventricular outflow tract (RVOT) collapse (* denotes pericardial effusion)
  3. Parasternal short axis view showing diastolic RVOT collapse
  4. M-mode images better demonstrating the timing of RVOT dip (note correlation with mitral E-wave [= early diastole])
  5. Apical 4-chamber view showing right atrial invagination and corresponding M-mode image
  6. Doppler images demonstrating respiratory variation in transvalvular flows
  7. Subxiphoid 4-chamber view
  8. IVC could not be visualized in this patient due to ADPKD, so including an illustrative image of plethoric IVC from a different case (* denotes pericardial effusion)

Repeat images obtained after 1.2 L ultrafiltration showing more pronounced RVOT collapse because we removed fluid from the intravascular compartment (= pericardial pressure > pressure inside the cardiac chamber).

Below is a nice infographic on this topic from Alerhand S, et al. Am J Emerg Med. 2022;58:159-174

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