Pericardial ultrasound

Indications for ultrasound examination of the pericardium

Suspected pericardial effusion. Echocardiography is a very specialized examination. In general echographic practice, researchers limit themselves to determining the presence of pericardial effusion.

Preparation for ultrasound of the pericardium

1. Patient preparation. No patient preparation is required.
2. Patient position. The patient is examined in a supine position, then in a sitting position. The gel is applied randomly to the heart area.
3. Selecting a transducer: Use a 3.5 MHz transducer. Use a 5 MHz transducer for children and thin adults. Use the smallest diameter transducer available to allow examination through the intercostal spaces.
4. Adjusting the sensitivity of the device. Begin the examination by placing the probe centrally in the upper abdomen (under the xiphoid process). Tilt the probe to the right until an image of the liver is obtained. Set the sensitivity level of the device to obtain optimal echogenicity and echostructure. The diaphragm should be visualized as a thin hyperechoic line along the posterior contour of the liver. The portal and hepatic veins should be visualized as tubular anechoic structures with an anechoic lumen. The walls of the portal vein are hyperechoic, the hepatic veins do not have hyperechoic walls.

Scanning technique

Begin the examination in the upper central abdomen with a small acoustic head transducer close to the costal margin under the xiphoid process.

Tilt the transducer upward toward the head and ask the patient to take a deep breath. This usually produces a cross-section of the heart, and the examination can then be performed throughout the respiratory cycle. If the transducer has a small enough scanning surface to allow examination through the intercostal spaces, various sections can be obtained. But usually, if the transducer is not small enough, the shadows from the ribs are superimposed on the image. The blood is anechoic. and the walls of the heart are echogenic. The diameter of the heart chambers changes depending on the stage of the cardiac cycle.

Pericardial effusion

Fluid around the heart is visualized as an anechoic band around the heart muscle. (Anterior anechoic fat can simulate fluid.) If there is a small amount of fluid, the shape of the band may vary depending on the phase of the cardiac cycle. With a moderate amount of fluid, the apex of the heart moves freely against the background of pericardial fluid. With a large effusion, cardiac contractions may be limited.

It is impossible to differentiate serous effusion and blood using echographic data. In pericardial effusion of tumor or tuberculous genesis after the acute stage, local or limited pericardial effusion can be determined due to the adhesion of two layers of the pericardium. Internal echostructure appears as a result of inflammation or hemorrhage. Calcification in the pericardium is better determined using radiography.

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