Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Case 39 Aortic pulsation artifact
- Case 40 Mediastinal widening due to non-hemorrhagic causes
- Case 41 Aortic injury with normal mediastinal width
- Case 42 Retrocrural periaortic hematoma
- Case 43 Mimicks of hemopericardium on FAST
- Case 44 Mimicks of acute thoracic aortic syndromes: aortic dissection, intramural hematoma, and penetrating aortic ulcer
- Case 45 Aortic intramural hematoma
- Case 46 Pitfalls in peripheral CT angiography
- Case 47 Breathing artifact simulating pulmonary embolism
- Case 48 Acute versus chronic pulmonary thromboembolism
- Case 49 Vascular embolization of foreign body
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Case 43 - Mimicks of hemopericardium on FAST
from Section 4 - Cardiovascular
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Case 39 Aortic pulsation artifact
- Case 40 Mediastinal widening due to non-hemorrhagic causes
- Case 41 Aortic injury with normal mediastinal width
- Case 42 Retrocrural periaortic hematoma
- Case 43 Mimicks of hemopericardium on FAST
- Case 44 Mimicks of acute thoracic aortic syndromes: aortic dissection, intramural hematoma, and penetrating aortic ulcer
- Case 45 Aortic intramural hematoma
- Case 46 Pitfalls in peripheral CT angiography
- Case 47 Breathing artifact simulating pulmonary embolism
- Case 48 Acute versus chronic pulmonary thromboembolism
- Case 49 Vascular embolization of foreign body
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Summary
Imaging description
During the focused assessment with sonography for trauma (FAST) scan, the epicardial fat pad can be mistaken for hemopericardium or a pericardial effusion [1]. This is more often seen in obese patients and can appear sonographically anechoic (Figure 43.1). To avoid this pitfall, Blaivas et al. suggest using a modified sub-xiphoid view [1]. In this technique the probe is angled perpendicular to the skin, visualizing the inferior vena cava (IVC) entering the right atrium, which allows visualization of the right side of the heart next to the diaphragm. Any amount of pericardial fluid that is not loculated will be seen in this location. Also, in this view the IVC should collapse at least 50% with a sudden inspiration. Collapse of less than 50% indicates increased central pressure, possibly due to tamponade. Imaging the IVC as it enters the heart can be performed quickly and does not add significant time to the FAST examination.
If differentiating between a hemopericardium and an epicardial fat pad remains difficult despite this technique, and the patient is stable, further imaging with computed tomography provides rapid differentiation (Figure 43.2).
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 144 - 145Publisher: Cambridge University PressPrint publication year: 2013