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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.

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Literature review current through: Nov 2017. | This topic last updated: Aug 18, 2017.
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