PERICARDIAL effusion is most often present in patients with uremia, viral pericarditis, and malignant neoplasms. It is also observed in many other conditions, including Dressler's syndrome, myxedema, collagen vascular diseases, congestive heart failure, lymphoma, sarcoidosis, and bacterial and tuberculous pericarditis.
Echocardiography is the method of choice for the diagnosis of pericardial effusion. This technique is highly accurate and reliable, but it is not used in all patients because frequently pericardial effusion is not clinically suspected. However, most patients with pericardial disease have plain chest roentgenograms, and in some of these the "water bottle" configuration of the heart leads to the proper diagnosis. The authors have found the epicardial fat sign to be useful in the diagnosis of pericardial effusion in patients in whom this condition is clinically not suspected and in whom the chest films show a normal heart configuration (Fig 1).
The epicardial fat sign as an aid in
Carsky EW, Azimi F, Mauceri R. Epicardial Fat Sign in the Diagnosis of Pericardial Effusion. JAMA. 1980;244(24):2762-2764. doi:10.1001/jama.1980.03310240054029