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
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This anteroposterior-view chest radiograph shows a massive, bottle-shaped heart and conspicuous absence of pulmonary vascular congestion. Reproduced with permission from Chest, 1996: 109:825.
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A 12-lead electrocardiogram showing sinus tachycardia with electrical alternans. Reproduced with permission from Chest, 1996; 109:825.
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Early diastolic collapse of right ventricular free wall (subcostal view).
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Early diastolic collapse of right ventricular free wall (parasternal short-axis view at aortic valve).
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Late diastolic collapse of right atrium (subcostal view).
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Dilated inferior vena cava.
