Evaluation of the pericardium

Echocardiography is the most important diagnostic modality in the management of pericardial diseases, and is the initial test of choice in cases of possible cardiac tamponade. It is extremely important to evaluate the pericardium during echocardiography, since it is a common cause of acute hemodynamic impairment. The pericardium consists of an outer sac called the fibrous pericardium and a two-layered inner sac that creates a potential space surrounding the heart called the serous pericardium. A pericardial effusion appears on echocardiogram as an echo-free space between the two layers of serous pericardium. The chapter discusses constrictive pericarditis caused by a noncompliant pericardium, and presents specific hemodynamic parameters developed to aid in the differentiation of restrictive cardiomyopathy from constrictive pericarditis. Effusive–constrictive pericarditis results from a combination of pericardial effusion and constrictive pericarditis. To make the diagnosis of effusive–constrictive pericarditis, constrictive hemodynamics must persist after removal of pericardial fluid.