Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Echocardiographic evaluation of the pericardium

Elyse Foster, MD
Section Editor
Warren J Manning, MD
Deputy Editor
Brian C Downey, MD, FACC


Echocardiography is the initial method of choice for evaluating most pericardial diseases, given its ability to provide both anatomic and physiologic/hemodynamic information. When competently performed in patients with good acoustic windows, echocardiography accurately detects pericardial effusions and provides clinically relevant information about their size and hemodynamic importance. The technique is less reliable than magnetic resonance imaging (MRI) and computed tomography (CT) in detecting pericardial thickening/constriction and calcification as well as small loculated effusions, but can still be extremely useful in these conditions. However, MRI is the preferred imaging modality for identifying pericardial inflammation/pericarditis.

A 2003 task force of the American College of Cardiology (ACC), the American Heart Association (AHA), and the American Society of Echocardiography (ASE) gave class I recommendations for the following uses of echocardiography in known or suspected pericardial disease (table 1) [1]:

Patients with suspected pericardial disease, including effusion, constrictive pericarditis, or effusive-constrictive pericarditis.

Patients with suspected bleeding into the pericardial space (eg, trauma, perforation).

Follow-up study to evaluate recurrence of effusion following treatment or to diagnose early constrictive pericarditis. Repeat studies may be goal directed to answer a specific clinical question.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2017. | This topic last updated: Dec 18, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline for the clinical application of echocardiography www.acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006).
  2. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965.
  3. Shah AB, Kronzon I. Congenital defects of the pericardium: a review. Eur Heart J Cardiovasc Imaging 2015; 16:821.
  4. Horowitz MS, Schultz CS, Stinson EB, et al. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation 1974; 50:239.
  5. Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med 2013; 369:1522.
  6. Chandraratna PA, Aronow WS. Detection of pericardial metastases by cross-section echocardiography. Circulation 1981; 63:197.
  7. Wilson SR, Kronzon I, Machnicki SC, Ruiz CE. A constrained heart: a case of sudden onset unrelenting chest pain. Circulation 2014; 130:1625.
  8. Van Son JA, Danielson GK, Schaff HV, et al. Congenital partial and complete absence of the pericardium. Mayo Clin Proc 1993; 68:743.
  9. Payvandi MN, Kerber RE. Echocardiography in congenital and acquired absence of the pericardium. An echocardiographic mimic of right ventricular volume overload. Circulation 1976; 53:86.
  10. Hynes JK, Tajik AJ, Osborn MJ, et al. Two-dimensional echocardiographic diagnosis of pericardial cyst. Mayo Clin Proc 1983; 58:60.