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We heartily agree with Dunn and colleagues that echocardiography is the gold standard for the diagnosis of pericardial effusion. The SCTL chest roentgenogram is intended to increase the sensitivity and specificity of the epicardial fat stripe sign—a radiological finding of pericardial effusion that is commonly cited in the radiological literature and employed in clinical practice.In our patients, the SCTL roentgenogram demonstrated the epicardial fat stripe sign in 86% of patients with a large pericardial effusion, as opposed to a 36% demonstration of the epicardial fat stripe sign by conventional lateral roentgenogram. Thus, while the SCTL roentgenogram was not perfect, it afforded a significant improvement for the detection of pericardial effusion over the conventional roentgenographic indicator. Since the inconvenience and cost of this additional roentgenogram view are minimal, the SCTL technique is recommended to improve the roentgenographic assessment of an enlarged cardiac silhouette or suspected pericardial effusion, especially
Heinsimer JA. Roentgenograms in Pericardial Effusion-Reply. JAMA. 1987;258(14):1890–1891. doi:10.1001/jama.1987.03400140052012
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