Valente Tullio, Pignatiello Maria, Sica Giacomo, Bocchini Giorgio, Rea Gaetano, Cappabianca Salvatore, Scaglione Mariano
Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy.
Radiol Med. 2021 Apr;126(4):527-543. doi: 10.1007/s11547-020-01303-x. Epub 2020 Nov 2.
The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
心包积液的临床谱范围从无害的浆液性液体到危及生命的血心包。急性胸痛/低血压的相似临床表现可能导致误诊。超声心动图是诊断心包积液及其病因的一线检查,但有时正确的心血管超声诊断也存在不同缺点。放射科医生报告称,急诊科进行的胸部多排CT检查数量在不断增加。多排CT现已成为一种既定的心脏成像补充方法,现在能够越来越准确地快速识别心包疾病。本综述的目的是讨论在急性临床环境中血心包的关键多排CT特征,这些特征表明需要主要进行药物治疗或手术治疗,然而,要能够识别仅需“观察等待策略”和/或延迟治疗的出血性心包积液形式。在急诊护理环境中,放射科医生必须了解血心包的不同表现,以便采取量身定制的及时管理方法。