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|Year : 1979 | Volume
| Issue : 4 | Page : 251-252
Lilam S Shah, AS Vengsarkar
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India
Lilam S Shah
Department of Cardiology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
Source of Support: None, Conflict of Interest: None
Detection of pericardial fluid by non-invasive ultrasonic technique is reported in a case of myxedema. Mediastinal swing and pseudo mitral valve prolapse are demonstrated. Equally increased thickness of the interventricular septum and left ventricular posterior wall may be due to myxedematous infiltrative changes.
|How to cite this article:|
Shah LS, Vengsarkar A S. Pericardial effusion. J Postgrad Med 1979;25:251-2
| :: Introduction|| |
Since last decade ultrasonic studies have made it possible to detect pericardial effusion non-invasively. Edler  made the diagnosis of pericardial effusion for the first time from echocardiographic studies in 1955. Since 1965 various reports have been published. ,,,,,,, regarding the detection of fluid and its quantitative assessment.
| :: Case report|| |
M. P., a 45 year old male was admitted with puffiness of face, oedema of feet and distension of the abdomen. The patient was a known case of myxedema and had received thyroxine in the past. Systemic examination revealed features of myxedema. CVS examination suggested the presence of pericardial effusion.
His echocardiogram revealed an echo free space in the anterior and posterior pericardial sac. There was significant mediastinal flutter as suggested by wide excursion of the right ventricular endocardium, septum and mitral valve. Mitral valve also showed pesudo prolapse of the anterial mitral leaflet. (See [Figure 1] on page 250B).
Pericardial paracentesis was done. 800 ml of pericardial fluid was obtained. The colour of the pericardial fluid was golden yellow (gold paint effusion). Pericardial fluid choesterol was 173 mg per 100 ml and the blood cholesterol was 250 mg per 100 ml.
Post-paracentesis echo showed loss of mediastinal flutter; there was no echolucent space in the posterior and anterior pericardial sac. (See [Figure 2] on page 250B).
Identically increased thickness of interventricular septum and left ventricular posterior wall suggested symmetric cardiac hypertrophy, possibly infiltrative in nature (myxaedematous infiltration).
| :: Discussion|| |
Detection of echolucent space in the anterior and posterior pericardial sac is diagnostic of pericardial effusion. With a significant accumulation of pericardial fluid, mediastinal swing is demonstrated as wide excursion of the right ventricular endocardium, septum and the mitral valve.  D'Cruz et al  have reported an increase in the right ventricular dimensions and decrease in the left ventricular dimensions in cardiac tamponade during inspiration. Same authors  have reported inspiratory decrease of mitral valve EF slope; the diminution of mitral valve opening suggests a compromise of the left ventricular filling during inspiration Late systolic prolapse of the anterior mitral leaflet has been described by Lemire et al.  Our case presents these echocardiographic findings. Identical hypertrophy of the interventricular septum, lei ventricular posterior wall and slow hear rate are highly suggestive of myxedema.
| :: References|| |
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|2.||D'Cruz, I. A., Cohen, H. C., Prabhu, F and Glick, G.: Diagnosis of cardiac tamponade by echocardiography. Changes in mitral valve motion and ventricular dimensions with special reference to paradoxis pulse. Circulation, 52: 460-465, 1975. |
|3.||Edler, I.: The diagnostic use of ultra sound in heart diseases. Acta Med Scandinav., 152 (supplement 308): 32-36 1955. |
|4.||Feigenbaum, H., Zaky, A., and Wald hausen J. A.: Use of reflected ultrasound in detecting pericardial effusion. Amer. J. Cardiol 19: 84-90 1967. |
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|7.||Goldberg, B. B., Ostrium, B. J. and Isard, H. J.: Ultrasonic determination of pericardial effusion. J. Amer. Med. Assoc., 202: 927-930, 1967. |
|8.||Horowitz, M. S., Schultz, C. S. Stinson, E. B., Harrison, D. C. and Popp, R. L.: Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation, 50: 239-247, 1974. |
|9.||Lemire, F., Tajik, A. J., Giuliani, E. R., Gau, G. T. and Schattenberg, T. T.: Further echocardiographic observation in pericardial effusion. Mayo Clin. Proc. 51: 13-18, 1976. |
|10.||Levisman, J. A. and Abbasi, A. S.: Abnormal motion of the mitral valve with pericardial effusion. Pseudo prolapse of the mitral valve. Amer. Heart J., 91: 18-20, 1976. |
|11.||Rothman, J., Chase, N. E., Kricheft H, Mayoral, K and Beranbaum, E. R.: Ultra sonic diagnosis of pericardial effusion.Circulation, 35: 358-364, 1967 |
[Figure 1], [Figure 2]