0:00

This is a patient again 47

0:03

year old female also presenting with

0:06

shortness of breath.

0:08

And I'm going to show you this.

0:12

So she's presenting to an outside institution shortness of

0:15

breath. No other symptoms.

0:20

I'm just going to give you a few minutes. Again. This

0:23

is a PE study.

0:28

Look at it. Look at all the

0:32

Associated findings if there are any Associated findings

0:44

and I'm going to ask Ashley real quick because we're running

0:47

out of time otherwise, and I want to discuss this case.

0:51

What is the most likely diagnosed so I

0:54

have you look at it? Is this a patient just in heart

0:57

failure?

1:00

Is this aphasian in real failure?

1:03

Is this an infectious pericarditis?

1:06

Or is this a malignant paragoditis?

1:09

So we have we have we're sort of a path situation.

1:12

We have three people thinking it's renal failure

1:15

and we have two people thinking it's a malignant

1:18

pericarditis. I really like this. I

1:21

really like that. We have people going both ways.

1:25

And so what what do we actually see here? Well,

1:28

we see a patient who has bilateral sizable plural effusions.

1:32

We also see a patient who has a pericardial effusion.

1:35

And we see closer a patient who has a pericardial

1:38

effusion and then a few lymph nodes that kind of linger there.

1:43

And then when you look closely at that pericardial effusion, I'm going

1:46

to stop here.

1:50

It's a very irregular pericardial effusion. It has sort of

1:53

a lumpy bumpy appearance on the surface and I'm gonna

1:56

go and show you this image.

1:59

because windowing helps

2:01

sometimes we just have to make it very dark to bring

2:04

out the things that we want to see notice how

2:07

the pericardial effusion goes here and then sort of stops and

2:10

then it you it has this bigger Mass like

2:14

density that sits here at the inners at

2:17

the corner of the right atrium the RCA

2:20

and the fat and notice how the fat is kind of distorted a

2:23

little bit.

2:25

So

2:27

the patient came back

2:29

and then looked like this.

2:33

Again, the lumpy bumpiness off that pairing

2:36

of that fat layer should always draw your

2:39

attention.

2:41

And notice how the right atrial

2:44

appendage is distorted and then we proceeded with

2:47

the patient having a pet.

2:49

And you can see that this is all.

2:52

pet avid

2:54

It's circumferentially pet Avid and the lumpy bumpiness

2:57

in the irregularity here off the indentations of

3:00

the pericardial fat were actually

3:03

all tumor. And this was a very very

3:06

large and rapidly growing Andrew sarcoma that

3:09

the patient had so it's important

3:12

when you look at these.

3:16

To look at the appearance of the pericardial infusion

3:19

and just look if it's circumferential and if

3:22

it's circumferential is it homogeneous or is there

3:25

anything that sticks out? And in this case obviously now it's

3:28

easier to see there was this one nodule that

3:31

stuck out.

3:33

It's displacing the fat. It's displacing the right age

3:36

of appendage. It's just looks weird and it has a slightly different

3:39

attenuation here and we're having

3:42

one question here. No, it's actually not a question.

3:45

It's a wow. Yeah, I agree. It's a while.

3:48

And so this was a primary cardiac engines

3:52

are coma and if you look closely patient also has a large mass

3:55

in their liver.

3:57

And the patient unfortunately is no longer with us with

4:00

us, but I just want to submit to you when you

4:03

see this and when you patient comes in and you

4:06

see a large pericardial effusion really make sure that you

4:09

understand why they have the pericardial effusion and not

4:12

every pericardial effusion is just heart failure.

4:15

Pericardial effusions can sometimes be

4:18

malignant and sometimes it really is

4:21

just the extra look at the Contour of

4:24

your fat dense. The fat again is

4:27

your friend, you know, the loss of fat here. You want

4:30

to see the fat going around you don't want to have like a

4:33

different densities structure and

4:36

then window it's always window. It makes sure that it always

4:39

has the same density because it's fluid

4:42

it should have the same density all over and here you can see that

4:45

there's actually spots that are a little bit of higher density and

4:50

And this was it?

4:52

and I

4:54

thank you all for your participation, and I hope that

4:57

I was able to show you some true. Do not

5:00

miss cases. I just gonna thank

5:03

you again, and I hope you enjoyed this and tune in

5:07

for for those case reviews. Bye.