What is the role of chest radiography in the diagnosis of acute pericarditis?

Updated: Apr 02, 2019
  • Author: Sean Spangler, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Chest radiography is not helpful in uncomplicated pericarditis. Patients with small effusions (less than a few hundred milliliters) may present with a normal cardiac silhouette. In one study, pleural effusions were seen in 33% of patients with pericarditis. Approximately 75% of the effusions were left-sided only.

A flask-shaped, enlarged cardiac silhouette may be the first indication of a large pericardial effusion (200-250 mL of fluid accumulation) or cardiac tamponade (see the following image). This occurs in patients with slow fluid accumulation, compared with a normal cardiac silhouette seen in patients with rapid accumulation and tamponade. Thus, the chronicity of the effusion may be suggested by the presence of a huge cardiac silhouette.

Chest radiographs revealing markedly enlarged card Chest radiographs revealing markedly enlarged cardiac silhouette and normal-appearing lung parenchyma in prepericardiocentesis (A) and postpericardiocentesis (B). Courtesy of Zhi Zhou, MD.

Go to Imaging in Constrictive Pericarditis for complete information on this topic.

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