Figure 1.

Transthoracic Echocardiogram Demonstrating Pericardial Tamponade in the Setting of Severe Pulmonary Hypertension

(A) The parasternal long-axis view demonstrating a large circumferential pericardial effusion with right ventricular (RV) outflow tract dilatation. (B) The parasternal short-axis view highlighting significant RV enlargement and a circumferential pericardial effusion. (C) The apical 4-chamber view in diastole demonstrating significant RV enlargement, a large circumferential pericardial effusion, and basal RV diastolic buckling. (D) The apical 4-chamber view at end-systole demonstrating left atrial systolic collapse. (E) The subcostal view in end-systole demonstrating large circumferential pericardial effusion, RV hypertrophy in this patient with known pulmonary hypertension, and left atrial systolic collapse. (F) The subcostal view in diastole demonstrating RV-free wall buckling consistent with tamponade physiology. (G) Mitral inflow velocities demonstrating significant respiratory variation (36%) consistent with pericardial tamponade. (H) Pulsed wave Doppler of the hepatic vein demonstrating respirophasic systolic flow reversal consistent with pericardial tamponade.