Localized PCE

I tend to think of pericardial effusions (PCE) as being very uniform around the heart. This one was very localized to the area noted on the image. The CT Abd. (I didn’t order it!) showed the same PCE.

The history was severe diarrhea and weakness. I was a bit worried about the dilated right ventricle until I remembered I had reviewed the echo on the EMR which showed severe tricuspid regurgitation and prior RV enlargement. Because of the RV dysfunction, I ignored the plump IVC and gave a fluid bolus anyway. The IVC was not reflecting fluid status because of the high R sided heart pressures.

[Editor’s note: Several points to highlight…
Localized PCEs aren’t that common, but they do happen as Lloyd’s case highlights.
Lloyd rightly points out that if a patient has chronically high right-sided pressures, a collapsing IVC may not be present even if the patient is volume depleted. Take your IVC scan with a huge grain of salt and use other data points to determine volume status.
Lastly, you may have noticed that this is a subxiphoid (SX) view (the giveaway is the liver in the near field). At EDE 2, we teach participants to avoid SX to judge the size of the RV because it commonly looks big relative to the LV, even in normal patients. But indeed, this RV is huge!].