Detection of pericardial effusion was the earliest clinical application of echocardiography. Diagnosing large effusions is a non issue .Assessing minimal effusions (Systolic vs diastolic echo free space) and associated thickened pericardium is tough even after 50 years of echocardiography.
Mainly , we are limited by the resolution power of echo. Further , lack of echocardiographic landmark for visceral layer of pericardium (It is same as epicardium !) makes diagnosis of thickened pericardium a real tough exercise.It is said , normal pericardium is less than 4mm .
Where to measure it ? how to measure is still not clear.
- Mild pericardial effusion is largely a benign finding in vast majority.
- But , even a minimally thickened pericardium due to active inflammation can be significant.
- Sticky pericardial effusion predispose to thickening and constriction.
- Early recognition of this dreaded pericardial pathology is essential to interrupt the inflammatory process.
- In CRF (With or without dialysis) even a minimal pericardial effusion can denote a dismal outcome .
Here is a link to Horowitz classification of mild pericardial effusion ...
It could help us understand, How thickened pericardium presents in echo. Of course, CT and MRI now have increased sensitivity for diagnosing pericardial thickening.