Cardiac tamponade

Case contributed by Rade Kovač
Diagnosis almost certain

Presentation

Dyspnea, cough and chest pain. Increased D-dimer. CTPA was done to exclude pulmonary embolism.

Patient Data

Age: 55 years
Gender: Male
ct

No filling defects are present in pulmonary arteries.

Pericardial effusion without pericardial thickening. There is reflux of contrast material into IVC and hepatic veins, mainly the right hepatic vein, as well as within the azygos vein. Bilateral moderate-sized pleural effusions and peribronchial thickening, with diffuse and patchy ground-glass opacities, probably indicating vascular congestion.

Signs of centrilobular emphysema in the upper portions of the lung.

Paramediastinal irregular soft-tissue mass in the right upper lobe with mediastinal and bilateral hilar lymphadenopathy. Small lymph nodes anterior to the pericardium and around gastric cardia.

Case Discussion

Cardiac tamponade is a clinical diagnosis that is usually confirmed with echocardiography. However, there are some CT findings which can suggest this diagnosis. This patient had both clinical and CT findings consistent with pericardial tamponade. The right upper lobe mass was confirmed to be non-small cell lung cancer.

Some of the reported findings on CT include:

  • enlargement of the SVC (diameter similar to or greater than that of the thoracic aorta)
  • enlargement of the IVC (diameter greater than twice that of the adjacent abdominal aorta)
  • periportal edema
  • reflux of contrast material within the IVC or azygos vein
  • enlargement of hepatic and renal veins
  • flattening or inversion of the right atrial or RV wall
  • inversion of the interventricular septum

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