Water bottle sign (heart)

Last revised by Dr Ian Bickle on 19 May 2021

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 liter or more, causes the pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3: annotated image
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  • Case 4
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  • Case 5
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  • Case 6: tuberculous pericardial effusion
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  • Case 7
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