Water bottle sign (heart)

The water bottle sign or configuration refers to the shape of the cardiac silhouette on erect frontal chest x-rays in patients who have a very large pericardial effusion. Typically the effusion has accumulated over many weeks to months (e.g. in patients with malignancy) and the pericardium has gradually stretched. The fluid, often measuring a litre or more, causes the pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

Chest x-ray
Inspired signs
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Article Information

rID: 15496
System: Chest
Section: Signs
Synonyms or Alternate Spellings:
  • Water bottle configuration
  • Water bottle heart

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Cases and Figures

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    Case 1
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    Pericardial effusion
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    Case 3: annotated image
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    Case 4
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