72 year old man with a history of mesothelioma presents with increasing shortness of breath.
Describe and interpret these scans
Image 1: A moderate sized pleural effusion is present. Fanning through the effusion the descending aorta is seen, then the heart – which is surrounded by a large pericardial effusion.
Image 2: Using the echo probe the pericardial effusion is again seen through the pleural effusion.
Image 3: Subcostal view: taken with the curvilinear probe confirms a large pericardial effusion with some right sided chamber collapse.
Pleural effusion and pericardial effusion with echocardiographic signs of tamponade
Rapid assessment of the chest in a deteriorating patient with known mesothelioma in whom previous pleural fluid drainage has been performed is extremely useful.
A pneumothorax, recurrent pleural effusion, or progression of solid malignancy may be playing a part.
Keeping an open mind is always important and in this case through the pleural effusion a large pericardial effusion is seen.