D'Cruz I A, Constantine A
Cardiology Section, VA Medical Center and Medical College of Georgia, Augusta 30910.
Echocardiography. 1993 Mar;10(2):151-66. doi: 10.1111/j.1540-8175.1993.tb00027.x.
The echocardiographic diagnosis of pericardial effusions is usually based on visualization of a sonolucent circumcardiac space of varying width. However, potential fallacies in interpretation can arise if sonolucent spaces adjacent to the heart (pleural effusions, ascites, pericardial cysts) are mistaken for pericardial effusions. Loculated pericardial effusions, especially if unusual in location or configuration, can cause diagnostic difficulty on occasion. The differential diagnosis of various "solid" echoes within a pericardial effusion is of clinical relevance, yet not widely discussed. Inflammatory tissue, neoplastic involvement, pus, caseous material, and extravasated blood all have characteristic echocardiographic morphologies. All of the various reported echocardiographic signs of tamponade do not have the same significance, so that caution is necessary not to over- or under-read tamponade. Chamber collapse can be absent in real tamponade in specific situations. On the other hand, "regional" tamponade can occur if loculated pericardial effusions are sufficiently large and high tension; echocardiographic appearances are "atypical" but diagnostically valuable if correctly interpreted. These and certain other unusual variants of tamponade deserve to be better known among echocardiographers not only because of their intrinsic interest, but also to avoid potential pitfalls in the echocardiographic assessment of patients with suspected disease.
心包积液的超声心动图诊断通常基于对不同宽度的心外无回声区的观察。然而，如果将心脏附近的无回声区（胸腔积液、腹水、心包囊肿）误认为心包积液，就可能出现解释上的错误。局限性心包积液，特别是位置或形态异常时，有时会导致诊断困难。心包积液内各种“实性”回声的鉴别诊断具有临床意义，但尚未得到广泛讨论。炎性组织、肿瘤浸润、脓液、干酪样物质和外渗血液都有特征性的超声心动图形态。各种已报道的心包填塞超声心动图征象并非都具有相同的意义，因此必须谨慎，避免对心包填塞的解读过度或不足。在特定情况下，真正的心包填塞可能不存在心腔塌陷。另一方面，如果局限性心包积液足够大且压力高，可能会发生“区域性”心包填塞；超声心动图表现“不典型”，但如果解释正确则具有诊断价值。这些以及其他一些不寻常的心包填塞变体不仅因其内在的趣味性而值得超声心动图医生更好地了解，还因为要避免在对疑似疾病患者进行超声心动图评估时可能出现的陷阱。
