PERICARDITIS WITH EFFUSION: NEW OBSERVATIONS, WITH A NOTE ON EWART'S SIGN

Abstract

Utilizing the method of Robb and Steinberg, (angiocardiography) the cardiovascular system in pericardial effusion was studied. Pericardial effusions begin in the infracardiac diaphragmatic portion of the pericardium. The heart is surrounded by fluid, except posteriorly, where pericardial reflections over the inferior vena cava below, the pulmonary veins, pulmonary artery and aorta above prevent accumulation of fluid. Because of the retrosternal pericardial accumulation, the blood-filled cardiovascular structures are forced backward, compress the lung and bronchi, and are responsible for Ewart''s sign. In massive pericardial effusions, marked distention of the lateral pericardial pouches occurs; they behave like inflated water wings, and cause additional compression, enhancing Ewart''s sign. Pericardial paracentesis through the posterior approach when made low in the thorax yields fluid either from the infracardiac pericardial space or from the distended lateral pericardial pouches. To avoid traversing lung, the anterior route in the region of the xiphoid process or apex of the heart is recommended for pericardial paracentesis.