ICU: Pericardial Tamponade

Beware of the importance of looking "all-around" when you are doing a "quick" echo when a baby is unstable, in the immediate postoperative period. (Poor image quality is part of the deal!)

The first two panels show no significant effusion. However, in the lower-most panel - angled more posteriorly - there is a localized collection of clot compressing right atrium and part of right ventricle. This was not recognized due to poor images. Chest was opened to cannulate for ECMO! Clot was noted in the pericardial space, compressing right atrium (Lower-most panel). Hemodynamic status improved when the clot was removed. ECMO was not necessary.

Newborn, s/p Arterial switch operation. 3 hrs postop.

Echo features of tamponade

14 yr old with history of intermittent facial swelling (SVC syndrome). Superior mediastinal widening and cardiomegaly on CXR.





Diastolic collapse of RV free wall.


Doppler equivalent of pulsus paradoxus (?!)

ICU: Pulsus Paradoxus

11 yr old female with respiratory distress.

Note the variation in arterial pressure and CVP.

Discuss the causes.

(Image courtesy: George Hartas)

How do you quantify pulsus paradoxus?

Echo: Cardiac Tamponade Video

Link to 2 nice videos

https://www.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Tamponade