Multimodality Imaging in the Evaluation of Cardiovascular Manifestations of Malignancy
Figure 8
Echo signs of tamponade. Diastolic inversion of the right atrial (RA) free wall is an early sign of raised intrapericardial pressure ((a) and (b)), white arrow—note collapse/inversion of the RA free wall in early diastole (b) as the intrapericardial pressure exceeds the RA pressure. Right ventricular diastolic inversion is a later but more specific sign of tamponade ((c) and (d)) asterisks outline the RV free wall—the RV shows diastolic collapse (d) due to the adjacent effusion (PE). Note also the relative enlargement of the left ventricle (LV) in this case; a result of chemotherapy-related cardiomyopathy. Doppler techniques are often very helpful in establishing the diagnosis of tamponade—transtricuspid flow variability of greater than 33% on a beat-to-beat basis ((e), asterisks represent peak transtricuspid flow for each recorded beat) is suggestive of tamponade. M-mode Doppler has a very high sampling (frame) rate compared to standard B-mode Doppler and is therefore useful for timing the motion of the RV free wall with respect to the cardiac cycle ((f), horizontal white arrows indicate the RV free wall; as would be expected this moves in normally during systole but is slow to move outwards in early-to-mid diastole (black asterisks)—in fact full outward excursion only occurs late in diastole (dotted short arrow) aided by the filling from atrial contraction (dotted long arrow indicates wave on ECG, i.e., atrial systole)).
