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Pericardial effusion

Case contributed by Assoc Prof Frank Gaillard





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.

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:

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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