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