Presentation
Chest penetrating trauma. Hx of metastatic melanoma.
Patient Data
Three linear metallic foreign bodies (nails from a nail gun) are projected in the central anterior chest wall on the frontal projection and over the anterior aspect of the cardiac shadow on the lateral projection.
Superior mediastinal widening. Left lung large rounded opacities. The lateral projection demonstrates the oreo cookie sign indicating a pericardial effusion. No evidence of PTX.
Three metallic foreign bodies (nails) in the anterior chest wall along the left sternal edge penetrate into the pericardial space. Associated pericardial effusion (blood). Anterior mediastinal stranding and hemorrhage.
Large left lung masses, enlarged lymph nodes and subcut nodules in keeping with metastatic melanoma.
The high density pericardial effusion corresponds the white cream center of the cookie, where as the pericardial and low density pericardial fat correspond to the black biscuit.
Case Discussion
Nice example of the oreo cookie sign of pericardial effusion on a lateral CXR secondary to hemopericardium from penetrating chest trauma.
Case courtesy of Dr Nivene Saad.
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