Purpose When tamponade develops in patients with pericarditis and intrapericardial adhesions, typical echocardiographic signs of tamponade may not be present. Selective tethering of areas of the ventricular and/or atrial epicardium to the parietal pericardium prevents “collapse” of chamber walls at these locations, while nontethered parts of the atria or ventricles are susceptible to high intrapericardial pressure and do show collapse. This situation shows unusual and even bizarre cardiac chamber configurations.
Methods/Results The selective tethering, the selective “collapse,” and the distribution of pericardial effusion causing regional tamponade can all be visualized on two-dimensional echocardiography in appropriate views. We identified 6 patients who had such echo appearances: 2 were post coronary artery bypass surgery, 1 had SLE, 1 had lung cancer, and in 2 the etiology was uncertain. Evidence of tamponade was based on hemodynamic data or on clinical signs of tamponade (tachycardia, hypotension, pulsus paradoxus, jugular venous distention), which promptly resolved on drainage of the effusion.
Conclusions Recognition of these features of regional tamponade enables clinicians to (1) diagnose tamponade even when conventional echo signs of tamponade are absent, (2) decide on site of pericardialcentesis or the need for surgical drainage, (3) explain perplexing echo configurations in such patients with pericardial effusions and adhesions.
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