Cardiac Tamponade Differential Diagnoses

Updated: Nov 28, 2018
  • Author: Chakri Yarlagadda, MD, FACC, FSCAI, FASNC, CCDS; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
  • Print

Diagnostic Considerations

Early diagnosis with a high index of suspicion is necessary to minimize morbidity and mortality from tamponade.

Large pleural effusion

Cases of cardiac tamponade have been reported with large pleural effusions. The increased intrapleural pressure resulting from large pleural effusions can be transmitted to the pericardial space and impair ventricular filling, thus producing the hemodynamic equivalent of cardiac tamponade.

Tension pneumopericardium

The hemodynamic changes in tension pneumopericardium simulate acute cardiac tamponade. Clinically, distant heart sounds, bradycardia, and shifting tympany occur over the precordium, and a characteristic murmur, termed bruit de la roue de moulin, is heard. This is usually observed in infants with mechanical ventilation but is also seen after sternal bone marrow aspiration, penetrating chest wall injury, esophageal rupture, and bronchopericardial fistula.

Rapid and labored breathing

Large decreases in intrathoracic pressure with deep inspirations, often observed during respiratory failure, can accentuate pulsus paradoxus, simulating pericardial tamponade.

Differential Diagnoses