Consistent with her diagnosis, the patient's erythrocyte sedimentation rate (ESR) was 109 mm/hr (nl 0-30mm/hr), C-reactive protein was 208 mg/L (nl <3.1), and she had a mild leukocytosis (10.1 k/ul). She was admitted to the Cardiology service and over the course of a week underwent pericardiocentesis, and later a pericardial window by the cardiothoracic service. Fortunately, no malignant cells were reported by pathology in either the pericardial fluid or pericardium sample.

She was discharged yesterday feeling much improved (8/2/06).

She had no signs of pretamponade/tamponade on her official echocardiogram. (fortunately, I saw none on the bedside echo in the CPU either!)

Pointers

-It is the rate of collection of an effusion that determines likelihood of tamponade, not the size of the effusion. As little as 50cc of fluid can produce frank tamponade if the accumulation is brisk. Many will tolerate a large effusion if it is chronic or slowly progressive.

-Tamponade impairs the filling of the right side of the heart. With impaired filling, one may see collapse of the right ventricle in diastole. This is sometimes referred to as "pretamponade" or "impending tamponade" if clinical signs of tamponade are absent (i.e., shortness of breath and hypotension).

-Collapse of the right ventricle in diastole is viewed well in a parasternal long axis view.

-Beck's triad is seen in less than 30% of patients with cardiac tamponade, and may be a late finding.

-Small effusions are characterized as less than 1cm thick, while "large" effusions are greater than 1-2 cm and frequently surround the heart.

Video of Tamponade in Subcostal View

Notice the "bowing" of the RV (chamber at top of picture) in diastole.

Thanks for looking!