The 2D echocardiographic characteristics of pleural effusion

Look for:

– Black fluid in the thoracic cavity – above the diaphragm (fluid can appear greyish)
– Atelectasis of the lung
– Diaphragm unusually clearly visible
– Lung sliding is absent in the phrenicocostal sinus

The video clips show 4 examples of pleural effusion

Notice:

– Black (or greyish) fluid collection in the thoracic cavity above the diaphragm
– Atelectasis of the lung
– Diaphragm is clearly visible
– Lung sliding is absent in the phrenicocostal sinus

Pulmonary edema – typical clinical conditions

Should be considered in particular with the following conditions:

– All respiratory compromising conditions
– All conditions with hemodynamic instabillity
– All cardiac failure patients
– COPD exacercabtion
– Shortness of breath, especially if arterial hypertension or hypotension is present
– Volume overload, verified or suspected
– Renal failure

Video clips of the subcostal 4 chamber view

Notice:

– Enlarged RV (arrows)
– RV size >2/3 of LV size
– Paradoxial movement of the interventricular septum

Right ventricle enlargement and myocardial dysfunction is seen in right side myocardial infarction and pressure increase (pulmonary embolus and chronic pulmonary hypertension)

Often a tricuspidal regurgitation is seen on colour Doppler (Advanced FATE level)

This view is not suitable for pressure measurement with continuous wave Doppler across the tricuspidal valve due to the angle of insonation (Advanced FATE level)

Pedunculated masses – 2D echocardiography

The characteristics:
– Abnormal pedunculated masses
– The vegetations often originate from valve leaflets but may originate from any
cardiac or vascular structure
– Myxomas often originate from the left atrium
– Thrombus mainly originates from low flow areas, atrial appendages, areas with
reduced myocardial movement, or aneurysms
– Exerts their “own” movement (2D and M-mode)
– Notice that pedunculated masses are not shown on the FATE card pictures

Consider in particular in the following conditions:
– Endocarditis
– Myxomas
– Thrombus
– Foreign material

Findings in patient with endocarditis affecting the aortic valves

All 4 video clips are from the same patient

A, B, C are all apical views for optimal display of the pedunculated mass

D is the corresponding TEE mid-esophageal 4 chamber view

Findings in patient with endocarditis affecting the mitral valves

The video clips are from 4 different patients

A, B, C are all apical views for optimal display of the pedunculated mass

D is the corresponding TEE mid-esophageal long axis view with pedunculated mass on the anterior mitral leaflet

Findings in patient with endocarditis affecting the tricuspid valves

The video clips A and D are from the same patient

A, C and D are subcostal views for optimal display of the pedunculated masses

B is a modified 4-chamber view for optimal display of the pedunculated masses

Video clips showing examples of pericardial effusion obtained in the apical 4-chamber view

Notice:

– Apical views
– Pericardial fluid collection (white arrows)
– Compression of right atrium is obvious in image B and is a
classical echocardiographic sign of tamponade, but not a prerequisite for a clinical tamponade syndrome

Video clips showing examples of pericardial effusion obtained in the subcostal 4-chamber view

Notice:

– S4CH views
– Pericardial fluid collection (white arrows)

Compression of the right sided cavities in diastole is not obvious in these clips