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Drs Engle and Upham, in their conclusion, state that a positive EFPS may be present not only with a pericardial effusion but also with pericardial thickening. We agree; however, the sign is more commonly seen with pericardial fluid than with thickening.We agree that the EFPS is positive in the patient described, and we can only speculate as to why the echocardiogram is negative for pericardial fluid.Considering the patient's clinical findings, it seems most likely that he had uremic pericarditis. The history of chronic renal failure and the presence of a friction rub in January 1981 when the EFPS was positive and also three months earlier support the diagnosis of uremic pericarditis.In uremic pericarditis there is fibrinous exudate that often results in adhesions between the visceral and parietal layers of the pericardium. This can cause fluid to be loculated and, if it is loculated anteriorly, a
Carsky EW, Azimi F, Mauceri R. Positive Epicardial Fat Pad Sign Without Pericardial Effusion-Reply. JAMA. 1982;247(12):1695–1696. doi:10.1001/jama.1982.03320370013010
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