Presentation
Shortness of breath.
Patient Data
Front chest x-ray demonstrates marked enlargement of the cardiac outline. This was due to pericardial effusion and is a good example of the water bottle sign. This refers to the shape of the cardiac silhouette on erect frontal chest x-rays in patients who have a very large pericardial effusion. The fluid, often measuring a liter or more, causes the pericardium to sag mimicking an old-fashioned water bottle sitting on a bench. Typically the effusion has accumulated over many weeks (e.g. in patients with malignancy) and the pericardium has gradually stretched.
Case Discussion
It is always worth remembering that although many radiologists will report chest x-rays as "the cardiac outline is enlarged" or even "the heart is enlarged", this is not always the case. Epicardial, anterior mediastinal or intrapericardial conditions can all look very similar.
In this case the patient had a large pericardial effusion, confirmed on echocardiography.
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