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Pericardial effusion

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

"CLL"

Chest

x-ray

Enlarged cardiac silhouette with globular shape, without evidence of pulmonary venous congestion. Lungs and pleural spaces are clear. 

Chest

ct

Pericardial effusion is evident (increased fluid-density around the heart) and this is the cause of the enlarged cardiac silhouette on chest x-ray. Numerous axillary and mediastinal lymph nodes.

Oreo cookie sign

Annotated image

Pericardial fluid (yellow *) outlined by paracardial fat (blue arrows) and epicardial fat (orange arrows), giving a three layered appearance, known as an Oreo cookie sign. 

Oreo Cakesters cookies, made by Nabisco. Photo by Evan-Amos. Original file: http://commons.wikimedia.org/wiki/File:Oreo-Cakesters.jpg

Case Discussion

Pericardial effusion in a woman with chronic lymphocytic leukemia (biopsy-proven). Chest x-rays demonstrate a globular shaped heart, without evidence of pulmonary venous congestion.

CT confirms the presence of a pericardial effusion as well as numerous axillary and mediastinal lymph nodes.

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