Role of Multimodal Cardiac Imaging in Pericardial Effusions and Tamponade
References
- Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003 Aug 14;349(7):684-90. doi: 10.1056/NEJMra022643
- Hoit BD. Pericardial disease and pericardial tamponade. Crit Care Med. 2007 Aug;35(8 Suppl):S355-64. doi: 10.1097/01.CCM.0000271159.84639.2B
- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-2964. doi: 10.1093/eurheartj/ehv318
- Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol. 2011 May 26;3(5):135-43. doi: 10.4330/wjc.v3.i5.135
- Vakamudi S, Ho N, Cremer PC. Pericardial Effusions: Causes, Diagnosis, and Management. Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):380-388. doi: 10.1016/j.pcad.2016.12.009
- Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol. 1990 Dec 15;66(20):1487-91. doi: 10.1016/0002-9149(90)90540-h
- Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007 Apr 25;297(16):1810-8. doi: 10.1001/jama.297.16.1810
- Curtiss EI, Reddy PS, Uretsky BF, Cecchetti AA. Pulsus paradoxus: definition and relation to the severity of cardiac tamponade. Am Heart J. 1988 Feb;115(2):391-8. doi: 10.1016/0002-8703(88)90487-5
- Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.e15. doi: 10.1016/j.echo.2013.06.023
- Klein AL, Wang TKM, Cremer PC, et al. Pericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging. JACC Cardiovasc Imaging. 2024 Aug;17(8):937-988. doi: 10.1016/j.jcmg.2024.04.010
- Wang TKM, Klein AL, Cremer PC, et al. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025 Dec 23;86(25):2691-2719. doi: 10.1016/j.jacc.2025.05.023
- Ebrahimi P, Taheri H, Bahiraie P, et al. Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature. J Cardiothorac Surg. 2025 Feb 22;20(1):
141 . doi: 10.1186/s13019-025-03370-5 - Savage DD, Garrison RJ, Brand F, et al. Prevalence and correlates of posterior extra echocardiographic spaces in a free-living population based sample (the Framingham study). Am J Cardiol. 1983 Apr;51(7):1207-12. doi: 10.1016/0002-9149(83)90370-3.
- Shanker DA, Gaur A, Warriner D. Pericardial Effusion: Overview of Aetiology, Pathophysiology, Diagnosis, and Management. Cureus. 2025 Sep 12;17(9):
e92177 . doi: 10.7759/cureus.92177 - Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013 Apr;34(16):1186-97. doi: 10.1093/eurheartj/ehs372
- Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004 Feb 28;363(9410):717-27. doi: 10.1016/S0140-6736(04)15648-1
- Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005 Dec 6;112(23):3608-16. doi: 10.1161/CIRCULATIONAHA.105.543066
- Ntsekhe M, Mayosi BM. Tuberculous pericarditis with and without HIV. Heart Fail Rev. 2013 May;18(3):367-73. doi: 10.1007/s10741-012-9310-6
- Burazor I, Imazio M, Markel G, Adler Y. Malignant pericardial effusion. Cardiology. 2013;124(4):224-32. doi: 10.1159/000348559
- Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J. 1999 Mar;137(3):516-21. doi: 10.1016/s0002-8703(99)70500-4
- Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. 2002 Oct;74(4):1148-53. doi: 10.1016/s0003-4975(02)03837-7
- Strobbe A, Adriaenssens T, Bennett J, et al. Etiology and Long-Term Outcome of Patients Undergoing Pericardiocentesis. J Am Heart Assoc. 2017 Dec 23;6(12):
e007598 . doi: 10.1161/JAHA.117.007598 - Lazaros G, Imazio M, Tsioufis P, Lazarou E, Vlachopoulos C, Tsioufis C. Chronic Pericardial Effusion: Causes and Management. Can J Cardiol. 2023 Aug;39(8):1121-1131. doi: 10.1016/j.cjca.2023.02.003
- Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown). 2010 Oct;11(10):712-22. doi: 10.2459/JCM.0b013e3283340b97
- Spodick DH. Pathophysiology of cardiac tamponade. Chest. 1998 May;113(5):1372-8. doi: 10.1378/chest.113.5.1372
- Bruch C, Schmermund A, Dagres N, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol. 2001 Jul;38(1):219-26. doi: 10.1016/s0735-1097(01)01313-4
- Ristić AD, Imazio M, Adler Y, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014 Sep 7;35(34):2279-84. doi: 10.1093/eurheartj/ehu217
- Pérez-Casares A, Cesar S, Brunet-Garcia L, Sanchez-de-Toledo J. Echocardiographic Evaluation of Pericardial Effusion and Cardiac Tamponade. Front Pediatr. 2017 Apr 24;5:
79 . doi: 10.3389/fped.2017.00079 - Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. 1999 Oct;138(4 Pt 1):759-64. doi: 10.1016/s0002-8703(99)70193-6
- Imazio M, Mayosi BM, Brucato A, et al. Triage and management of pericardial effusion. J Cardiovasc Med (Hagerstown). 2010 Dec;11(12):928-35. doi: 10.2459/JCM.0b013e32833e5788
- Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. 1984 Mar;69(3):506-11. doi: 10.1161/01.cir.69.3.506
- Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 2010 Jun;3(6):650-60. doi: 10.1016/j.jcmg.2010.04.009
- Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med. 2019 Feb;37(2):321-326. doi: 10.1016/j.ajem.2018.11.004
- Fowler NO. Cardiac tamponade. A clinical or an echocardiographic diagnosis? Circulation. 1993 May;87(5):1738-41. doi: 10.1161/01.cir.87.5.1738
- Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE. Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation. 1983 Aug;68(2):294-301. doi: 10.1161/01.cir.68.2.294
- Armstrong WF, Schilt BF, Helper DJ, Dillon JC, Feigenbaum H. Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation. 1982 Jun;65(7):1491-6. doi: 10.1161/01.cir.65.7.1491
- Chuttani K, Pandian NG, Mohanty PK, et al. Left ventricular diastolic collapse. An echocardiographic sign of regional cardiac tamponade. Circulation. 1991 Jun;83(6):1999-2006. doi: 10.1161/01.cir.83.6.1999
- Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1988 Dec;12(6):1470-7. doi: 10.1016/s0735-1097(88)80011-1
- Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8. doi: 10.1016/j.echo.2010.05.010
- Appleton CP, Hatle LK, Popp RL. Cardiac tamponade and pericardial effusion: respiratory variation in transvalvular flow velocities studied by Doppler echocardiography. J Am Coll Cardiol. 1988 May;11(5):1020-30. doi: 10.1016/s0735-1097(98)90060-2
- Leeman DE, Levine MJ, Come PC. Doppler echocardiography in cardiac tamponade: exaggerated respiratory variation in transvalvular blood flow velocity integrals. J Am Coll Cardiol. 1988 Mar;11(3):572-8. doi: 10.1016/0735-1097(88)91533-1
- Burstow DJ, Oh JK, Bailey KR, Seward JB, Tajik AJ. Cardiac tamponade: characteristic Doppler observations. Mayo Clin Proc. 1989 Mar;64(3):312-24. doi: 10.1016/s0025-6196(12)65251-3
- Oh JK, Hatle LK, Seward JB, et al. Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol. 1994 Jan;23(1):154-62. doi: 10.1016/0735-1097(94)90514-2
- Appleton CP, Hatle LK, Popp RL. Superior vena cava and hepatic vein Doppler echocardiography in healthy adults. J Am Coll Cardiol. 1987 Nov;10(5):1032-9. doi: 10.1016/s0735-1097(87)80343-1
- Feigenbaum H, Waldhausen JA, Hyde LP. Ultrasound diagnosis of pericardial effusion. JAMA. 1965 Mar 1;191:711-4. doi: 10.1001/jama.1965.03080090025006
- Eisenberg MJ, Oken K, Guerrero S, Saniei MA, Schiller NB. Prognostic value of echocardiography in hospitalized patients with pericardial effusion. Am J Cardiol. 1992 Oct 1;70(9):934-9. doi: 10.1016/0002-9149(92)90742-h
- Wang ZJ, Reddy GP, Gotway MB, Yeh BM, Hetts SW, Higgins CB. CT and MR imaging of pericardial disease. Radiographics. 2003 Oct;23 Spec No:S167-80. doi: 10.1148/rg.23si035504
- Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology. 2013 May;267(2):340-56. doi: 10.1148/radiol.13121059
- Moncada R, Baker M, Salinas M, et al. Diagnostic role of computed tomography in pericardial heart disease: congenital defects, thickening, neoplasms, and effusions. Am Heart J. 1982 Feb;103(2):263-82. doi: 10.1016/0002-8703(82)90499-9
- Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. Radiographics. 2007 Nov-Dec;27(6):1595-610. doi: 10.1148/rg.276065002
- Gold MM, Spindola-Franco H, Jain VR, Spevack DM, Haramati LB. Coronary sinus compression: an early computed tomographic sign of cardiac tamponade. J Comput Assist Tomogr. 2008 Jan-Feb;32(1):72-7. doi: 10.1097/rct.0b013e31815b3ebf
- Rienmüller R, Gröll R, Lipton MJ. CT and MR imaging of pericardial disease. Radiol Clin North Am. 2004 May;42(3):587-601, vi. doi: 10.1016/j.rcl.2004.03.003
- Verhaert D, Gabriel RS, Johnston D, Lytle BW, Desai MY, Klein AL. The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging. 2010 May;3(3):333-43. doi: 10.1161/CIRCIMAGING.109.921791
- Mulvagh SL, Rokey R, Vick GW 3rd, Johnston DL. Usefulness of nuclear magnetic resonance imaging for evaluation of pericardial effusions, and comparison with two-dimensional echocardiography. Am J Cardiol. 1989 Nov 1;64(16):1002-9. doi: 10.1016/0002-9149(89)90798-4
- Aldweib N, Farah V, Biederman RWW. Clinical Utility of Cardiac Magnetic Resonance Imaging in Pericardial Diseases. Curr Cardiol Rev. 2018;14(3):200-212. doi: 10.2174/1573403X14666180619104515
- Cremer PC, Tariq MU, Karwa A, et al. Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 2015 May;8(5):
e003125 . doi: 10.1161/CIRCIMAGING.114.003125 - Francone M, Dymarkowski S, Kalantzi M, Rademakers FE, Bogaert J. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol. 2006 Apr;16(4):944-51. doi: 10.1007/s00330-005-0009-0
- Giorgi B, Mollet NR, Dymarkowski S, Rademakers FE, Bogaert J. Clinically suspected constrictive pericarditis: MR imaging assessment of ventricular septal motion and configuration in patients and healthy subjects. Radiology. 2003 Aug;228(2):417-24. doi: 10.1148/radiol.2282020345
- Tsang TS, Freeman WK, Sinak LJ, Seward JB. Echocardiographically guided pericardiocentesis: evolution and state-of-the-art technique. Mayo Clin Proc. 1998 Jul;73(7):647-52. doi: 10.1016/S0025-6196(11)64888-X
- Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002 May;77(5):429-36. doi: 10.4065/77.5.429
- Flint N, Siegel RJ. Echo-Guided Pericardiocentesis: When and How Should It Be Performed? Curr Cardiol Rep. 2020 Jun 22;22(8):
71 . doi: 10.1007/s11886-020-01320-2 - Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med. 2003 Apr;253(4):411-7. doi: 10.1046/j.1365-2796.2003.01103.x
- Kopecky SL, Callahan JA, Tajik AJ, Seward JB. Percutaneous pericardial catheter drainage: report of 42 consecutive cases. Am J Cardiol. 1986 Sep 15;58(7):633-5. doi: 10.1016/0002-9149(86)90290-0
- El-Husseini W, Pravečková A, Kočková R, Marek T, Frídl P, Kautzner J. Pericardiocentesis guided by echocardiography performed in echocardiography laboratory – Safety profile of the single center prospective registry. Cor Vasa. 2015 Aug; 57 (4):e239-e244. doi: 10.1016/j.crvasa.2015.07.001
- Luis SA, Kane GC, Luis CR, Oh JK, Sinak LJ. Overview of Optimal Techniques for Pericardiocentesis in Contemporary Practice. Curr Cardiol Rep. 2020 Jun 19;22(8):
60 . doi: 10.1007/s11886-020-01324-y - Vayre F, Lardoux H, Pezzano M, Bourdarias JP, Dubourg O. Subxiphoid pericardiocentesis guided by contrast two-dimensional echocardiography in cardiac tamponade: experience of 110 consecutive patients. Eur J Echocardiogr. 2000 Mar;1(1):66-71. doi: 10.1053/euje.1999.0003
- Maggiolini S, Gentile G, Farina A, et al. Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure. Am J Cardiol. 2016 Apr 15;117(8):1369-74. doi: 10.1016/j.amjcard.2016.01.043
- Tsang TS, Barnes ME, Hayes SN, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest. 1999 Aug;116(2):322-31. doi: 10.1378/chest.116.2.322
- Imazio M, Gaita F. Acute and Recurrent Pericarditis. Cardiol Clin. 2017 Nov;35(4):505-513. doi: 10.1016/j.ccl.2017.07.004
- Sagristà-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. 1999 Dec 30;341(27):2054-9. doi: 10.1056/NEJM199912303412704
- Chetrit M, Xu B, Kwon DH, et al. Imaging-Guided Therapies for Pericardial Diseases. JACC Cardiovasc Imaging. 2020 Jun;13(6):1422-1437. doi: 10.1016/j.jcmg.2019.08.027
- Imazio M, Colopi M, De Ferrari GM. Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes. Heart. 2020 Apr;106(8):569-574. doi: 10.1136/heartjnl-2019-315852
- Wang TKM, Klein AL. Multi-Modality Cardiac Imaging for Pericardial Diseases: A Contemporary Review. Rev Cardiovasc Med. 2022 Oct 10;23(10):
336 . doi: 10.31083/j.rcm2310336 - Meziane MA, Fishman EK, Siegelman SS. CT diagnosis of hemopericardium in acute dissecting aneurysm of the thoracic aorta. J Comput Assist Tomogr. 1984 Feb;8(1):10-4. doi: 10.1097/00004728-198402000-00002
- Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013 Oct 17;369(16):1522-8. doi: 10.1056/NEJMoa1208536
- Klein AL, Imazio M, Cremer P. Phase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis. N Engl J Med. 2021 Jan 7;384(1):31-41. doi: 10.1056/NEJMoa2027892
- Brucato A, Imazio M, Gattorno M, et al. Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical Trial. JAMA. 2016 Nov 8;316(18):1906-1912. doi: 10.1001/jama.2016.15826
- De Filippo O, Gatti P, Rettegno S, et al. Is pericardial effusion a negative prognostic marker? Meta-analysis of outcomes of pericardial effusion. J Cardiovasc Med (Hagerstown). 2019 Jan;20(1):39-45. doi: 10.2459/JCM.0000000000000720
- Lestuzzi C. Neoplastic pericardial disease: Old and current strategies for diagnosis and management. World J Cardiol. 2010 Sep 26;2(9):270-9. doi: 10.4330/wjc.v2.i9.270
- El Haddad D, Iliescu C, Yusuf SW, et al. Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion. J Am Coll Cardiol. 2015 Sep 8;66(10):1119-28. doi: 10.1016/j.jacc.2015.06.1332
- Ahmed T, Mouhayar E, Song J, et al. Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis. Front Cardiovasc Med. 2022 May 31;9:
916325 . doi: 10.3389/fcvm.2022.916325 - Sagristà-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. 1999 Dec 30;341(27):2054-9. doi: 10.1056/NEJM199912303412704
- Al-Kazaz M, Klein AL, Oh JK, et al. Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024 Aug 6;84(6):561-580. doi: 10.1016/j.jacc.2024.05.048
- Sagristà-Sauleda J, Angel J, Sánchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. N Engl J Med. 2004 Jan 29;350(5):469-75. doi: 10.1056/NEJMoa035630
- Miranda WR, Oh JK. Effusive-Constrictive Pericarditis. Cardiol Clin. 2017 Nov;35(4):551-558. doi: 10.1016/j.ccl.2017.07.008
- Feng D, Glockner J, Kim K, et al. Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy: a pilot study. Circulation. 2011 Oct 25;124(17):1830-7. doi: 10.1161/CIRCULATIONAHA.111.026070
- Fenstad ER, Le RJ, Sinak LJ, et al. Pericardial effusions in pulmonary arterial hypertension: characteristics, prognosis, and role of drainage. Chest. 2013 Nov;144(5):1530-1538. doi: 10.1378/chest.12-3033
- Hinderliter AL, Willis PW
4th , Long W, et al. Frequency and prognostic significance of pericardial effusion in primary pulmonary hypertension. PPH Study Group. Primary pulmonary hypertension. Am J Cardiol. 1999 Aug 15;84(4):481-4, A10. doi: 10.1016/s0002-9149(99)00342-2 - Vasquez MA, Iskander M, Mustafa M, et al. Pericardiocentesis Outcomes in Patients With Pulmonary Hypertension: A Nationwide Analysis from the United States. Am J Cardiol. 2024 Jan 1;210:232-240. doi: 10.1016/j.amjcard.2023.10.047
DOI: https://doi.org/10.14797/mdcvj.1784 | Journal eISSN: 1947-6108
Language: English
Page range: 60 - 73
Submitted on: Jan 13, 2026
Accepted on: Feb 11, 2026
Published on: Mar 10, 2026
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Rohan A. Gajjar, Tahir S. Kafil, Sushil Allen Luis, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.