Case report
Tension pericardial collections: sign of ‘flattened heart’ in CT

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Cited by (25)

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  • Approach to Abnormal Chest Computed Tomography Contrast Enhancement in the Hospitalized Patient

    2020, Radiologic Clinics of North America
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    Indirect CT findings that suggest elevated filling pressures include enlargement of the superior vena cava greater than the diameter of the thoracic aorta, distention of the IVC, reflux of contrast into the azygos vein or IVC, dependent pooling of contrast, and enlargement of the hepatic veins.12 Flattening of the right heart chambers (the flattened heart sign), leftward bowing of the interventricular septum, and compression of intrapericardial structures like the pulmonary trunk or coronary sinus are more direct findings that can increase confidence in the diagnosis.12,13 Causes of tamponade are numerous and include hemopericardium, other pericardial fluid such as malignant effusion or pericarditis, and rarely air resulting in tension pneumopericardium.12

  • Role of Postmortem CT in the Forensic Evaluation of Hemopericardium

    2019, Seminars in Ultrasound, CT and MRI
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    A brief explanation of the pathophysiological mechanisms causative for some of these findings follows. The FHS22 occurs when the increase of the intrapericardial pressure is so high to cause during diastolic phase a transient reversal of the transmural left ventricular pressure. In these conditions a change in the contour of the anterior aspect of the heart characterized by a flattening of the anterior wall of the right ventricle with decrease of the cardiac anteroposterior diameter is observed.

  • Virtopsy Computed Tomography in Trauma: Normal Postmortem Changes and Pathologic Spectrum of Findings

    2015, Current Problems in Diagnostic Radiology
    Citation Excerpt :

    “Vanishing aorta” sign is a specific PMCT sign described in chest, in which the aorta is small and indiscernible on PMCT and suggests exsanguination of any origin as a cause of death16 (Fig 17). Other specific signs in chest described on PMCT include “hyperdense armored heart” and “flattened heart,” suggestive of active intrapericardial bleeding leading to cardiac tamponade effect as a cause of death vs passive accumulation of blood in pericardial sac (hemopericardium)27-29 (Figs 18 and 19). Aortic rupture is another suggestive cause of death that can be detected on PMCT.

  • Forensic relevance of post-mortem CT imaging of the haemopericardium in determining the cause of death

    2014, Legal Medicine
    Citation Excerpt :

    Other findings include the compression of the coronary sinus [10] and angulation or bowing of the interventricular septum [11–13]. Furthermore, Hernandez-Luyando et al. [14] and Restrepo et al. [15] described the presence of a “flattened heart sign” (i.e., flattening of the anterior surface of the heart with a decreased antero-posterior diameter) (FHS) as a change in the contour in the anterior aspect of the heart, which occurs in vivo when an increase in intrapericardial intrapressure is sufficient to produce a transient reversal of the transmural left ventricular pressure during diastole. The simultaneous presence of all of these signs and of a large pericardial effusion strongly suggests a diagnosis of PT in vivo [15].

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