Abstract
1191
Purpose: We will demonstrate two cases of pericardial effusions with their imaging findings on 2 different types of myocardial imaging studies. The first case is the more classic presentation of a patient with a pericardial effusion seen on a multigated radionuclide angiography (MUGA) study. The second case is the less frequently seen presentation of a pericardial effusion on a myocardial perfusion imaging (MPI) study. 1. The first patient, a 35-year-old male, presented to the hospital with complaints of worsening shortness of breath. His initial laboratory blood work demonstrated WBC count greater than 100,000 and Hb of 5. Hematology and oncology was consulted and further work up was obtained and the patient was diagnosed with Acute myeloid leukemia. Prior to starting the chemotherapy, multigated radionuclide angiography was ordered for baseline evaluation of myocardial contractility. The MUGA demonstrated normal wall motion and thickening in all left ventricular walls. The left ventricular ejection fraction average at rest is 66.5%. Additionally the images demonstrated a significant area of relative photopenia surrounding the myocardium which was highly suspicious for a significant pericardial effusion. The attending physician was notified of the above results. A subsequently obtained echocardiogram revealed a moderate to large pericardial effusion that was concerning for potential cardiac tamponade. Patient was transferred to coronary care unit for further management. Pericardiocentesis was performed and 705 ccs of fluid was removed. 2. The second patient was a 76-year-old woman with history of stage V chronic kidney disease, diabetes and hyperlipidemia presenting for the evaluation of her myocardial perfusion. Review of perfusion images is non-contributory but review of the raw rotating images demonstrates relative photopenia surrounding the heart. The gated cardiac images also demonstrated a "rocking" type motion during the cardiac cycle without definite patient motion seen on the resting or supine post stress images. These results were communicated to the ordering provider. Subsequently obtained echocardiogram demonstrated a large pericardial effusion.
Conclusions: These cases illustrate two different ways that an important clinical finding, a pericardial effusion, can present on different myocardial imaging studies. The more common presentation on a MUGA study and the less common presentation on an myocardial perfusion study. The interpreting physician needs to always be looking for signs of this finding since the timely communication of this incidental finding to the referring physician is essential.
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