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Pericardial effusion

Case contributed by Assoc Prof Frank Gaillard

Presentation

"CLL"

X-ray

Chest

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

CT

Chest

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.

Annotated image

Oreo cookie sign

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.

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Case information

rID: 8694
Published: 23rd Feb 2010
Last edited: 11th Apr 2020
System: Chest
Inclusion in quiz mode: Included

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