Ultrasonic detection of pericardial effusions adjacent to the right atrium during routine examination of the upper abdomen.

Pericardial effusions are usually detected on ultrasound by examining the heart with time--motion (T/M) or real-time equipment through a left chest intercostal space. Since fluid within the pericardium also accumulated around the right atrium, effusions can also be diagnosed by observing fluid separating the right atrium from hemidiaphragm on parasagittal scans of the right upper abdomen. In order to be certain that this space represents pericardial rather than pleural fluid, the inferior vena cava must be identified along the lower margin of the fluid space as a tubular structure traversing from the diaphragm into the right atrium. Our procedure is proposed as an ancillary approach for detecting clinica-ly unsuspected effusions during the routine examination of the upper abdomen rather than as a replacement for the usual method of visualising pericardial effusions.