April 1, 2006
Bedside trick ! - To suspect Pericardial Effusion on CXR reading
Pericardial effusion may be difficult to rule out on CXR.
Most patients in ICU have a heart rate of more than 100 bpm. X-ray exposure is usually long enough to allow the heart border to move significantly. If the heart borders are sharply demarcated, consider a pericardial effusion. In other words, in normal CXR you may see little haziness at borders due to movement of heart borders inside pericardium which get lost with pericardial effusion.
Another sign is presence of a thick pericardial fat stripe seen on the lateral view. Please see CXR in this regard here from teaching files of University of Ottawa.