A 65 yr. old man developed severe acute onset breathlessness within few hours of an aortic valve replacement. X-Ray diagnosis is?
Ans. C. Pericardial tamponadeCardiac tamponadea. Gradual accumulation of pericardial fluid may fail to produce clinical signs or symptoms for an extended period of time.b. However, rapid accumulation of as little as 100-200ml of fluid can cause a hemodynamically significant compression of the heart, which severely impedes diastolic filling, the condition known as pericardial tamponade.c. Even in the face of preserved ejection fraction, diminished ventricular end-diastolic volume leads to reduced stroke volume.d. In addition to other clinical signs of pericardial effusion those of cardiac tamponade include pulsus paradoxus, which is exaggeration of the normal inspiratory drop in systolic blood pressure. Since acute tamponade may occur with small effusions, clinically important pericardial enlargement may be difficult to detect on plain radiographs.e. Subtle changes in cardiac contour may only be detectable by comparison with previous studies. If there is decreased pulmonary vascularity in spite of the cardiac enlargement or if the superior vena cava and azygos veins are dilated, tamponade should be suspected.f. Echocardiographic demonstration of Pericardial effusion and the clinical findings are usually sufficient to make the diagnosis of tamponade. CT and MRI are frequently instrumental in suggesting the cause of the effusion (i.e. hemorrhage, neoplastic involvement, inflammation due to tuberculosis, or other infectious processes, etc.).
Gross bilateral pleural effusion
Left tension pneumothorax
Pericardial tamponade
Entire left lung collapse
Respiratory System