Chest Pain and Dyspnea

This week's "Image of the Week" is brought to you by Dr. Wallenstein. While evaluating a patient with chest pain and shortness of breath, he identified a concerning pericardial effusion.

Check out the video below:

 

In the video, note the subtle indention of the right ventricle (RV) during diastole in the setting of an obvious pericardial effusion. This finding is suggestive of cardiac tamponade. The classic findings of Beck's Triad (hypotension, distended neck veins, and muffled heart sounds) are frequently ABSENT.  So bedside ultrasound can assist in making the diagnosis.  

Sonographic signs of tamponade include a pericardial effusion with indention of the RV during diastole. In addition, imaging the inferior vena cava (IVC) should show a "plethoric" or dilated IVC with minimal respiratory variation.