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Case contributed by Krister Askaner
Diagnosis certain


Chest pain. Fever and chills. Abnormal ECG. CRP 145.

Patient Data

Age: 45 years
Gender: Male

Lateral CXR shows pericardial effusion (arrows). This appearance is called the "oreo cookie" sign. The most anterior radiolucent line represents the epicardial fat and the posterior radiolucent line the pericardial fat. Between these layers there is fluid of higher attenuation.
On the same image there is blunting of the posterior pleural sinus, evidence of pleural effusion.


Confimation of presence of pericardial effusion and bilateral pleural effusions.

Case Discussion

Pericardial effusion on chest x-ray can be overlooked due to the subtle findings, especially in cases when the cardiac silhouette is not significantly enlarged. In more severe cases, the cardiac silhouette on the frontal chest x-ray is enlarged and the configuration may resemble a water bottle.

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