Presentation
Chest pain, palpitations, and shortness of breath.
Patient Data
Even on this projection the cardiac silhouette is enlarged. No focal consolidation. Small left pleural effusion.
There is a large pericardial effusion. The fluid measures up to 21 mm in maximum in depth posterolaterally on the left and has an average density of less than 20 HU. No evidence of acute hemopericardium.
Case Discussion
The vast majority of cardiac silhouette enlargement is going to be from cardiomegaly, but occasionally it will be from a pericardial effusion. There are a few signs (e.g. water bottle sign, Oreo cookie sign), but often no differentiation can be made.
Echocardiography is the easiest modality to assess for pericardial effusion (this patient was clinically suspected of having aortic dissection, hence the CT angiogram).
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