Pericardial effusion and cardiac tamponade

Pericardial effusion (Peff) is a commonly encountered findings in clinical practice. It is usually asymptomatic, but can present as a life-threatening condition when cardiac tamponade ensues. The use of multimodality cardiac imaging has emerged as a crucial tool in the early detection and characterization of Peff and cardiac tamponade allowing prompt and effective treatment. Transthoracic echocardiography (TTE) is first-line imaging technique in the evaluation for Peff and cardiac tamponade. They key echocardiographic findings supporting cardiac tamponade include the presence of (1) cardiac chambers collapse; (2) an exaggerated ventricular interdependence; and (3) plethoric inferior vena cava (IVC). Advance cardiac imaging including transoesophageal echocardiography, cardiac CT, and cardiac MRI are reserved for complex cases with high suspicion for focal effusion or tamponade when TTE is unrevealing. Medical treatment of underlying cause is recommended for effusion without haemodynamic compromise, while emergent drainage is warranted when in cardiac tamponade.