Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT find
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CARDIAC RADIOLOGY
Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT findings? Tullio Valente1 · Maria Pignatiello2 · Giacomo Sica1 · Giorgio Bocchini1 · Gaetano Rea1 · Salvatore Cappabianca2 · Mariano Scaglione3,4,5 Received: 23 June 2020 / Accepted: 20 October 2020 © Italian Society of Medical Radiology 2020
Abstract The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only “a watch and wait strategy” and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach. Keywords Pericardial disease · Hemorrhagic effusion · Etiology · Diagnosis · Management · Computed Tomography
Introduction The clinical spectrum of pericardial effusion ranges from innocuous pericardial serous fluid to life threatening large hemopericardium (HP) up to cardiac tamponade. The rapid accumulation of pericardial effusion can have Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11547-020-01303-x) contains supplementary material, which is available to authorized users. * Tullio Valente [email protected] 1
Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
2
Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
3
Department of Diagnostic Imaging, Pineta Grande Hospital, Castelvolturno, Italy
4
Department of Radiology, Tesside University, Middlesbrough, UK
5
James Cook University Hospital, Middlesbrough, UK
dire hemodynamic consequences [1]. HP comprises sanguineous pericardial effusions (which does not clot), frank blood due to lesions, or rupture into the pericardium of cardiovascular structures [2]. Patients with hemorrhagic pericardial effusion may have a wide variety of cardiovascular and systemic pathologies (Table 1). A misdiagnosis is made because of the similar clinical presentation of acute chest pain, dysp
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