Echocardiography in pericardial disease.

In the years since its inception, echocardiography has done much to aid in the recognition and therapy of pericardial disease. Because it is the most sensitive test known for the detection of pericardial fluid, it has replaced most other diagnostic modalities for this purpose. The detection of phasic reciprocal ventricular dimension changes, systolic and diastolic compression or invagination of the right ventricle, and pendular and rotational motion of the entire heart in the setting of large pericardial effusions has added to our understanding of phenomena such as cardiac tamponade, pulsus paradoxus, and electrical alternans. Constrictive pericarditis is associated with an impressive array of echocardiographic abnormalities. However, the echocardiographic diagnosis of constrictive pericarditis remains elusive. Investigation continues for echocardiographic findings of high sensitivity and specificity for the diagnosis of tamponade and constriction. Meanwhile, echocardiography will continue to be a very useful adjunct to clinical, hemodynamic, and angiographic assessment.