UMEM Educational Pearls


46 year-old female found unresponsive at a party. EMS transports the patient in cardiac arrest. A parasternal-long axis view of the heart is obtained during the pulse check. What's the diagnosis?




The heterogeneous appearance of the pericardial fluid indicates that is likely a complex pericardial effusion; the fluid could be blood, pus, or a malignant effusion.

Differential diagnosis of hemopericardium includes:

  • Ascending aortic dissection
  • Cardiac free-wall rupture
  • Blunt / penetrating trauma
  • Coagulopathies
  • Metastasis to the pericardium

Based on this initial ECHO, a pericardiocentesis was performed and blood was aspirated.


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