Acute hemorrhagic pericardial effusion manifest as a discrete echo-dense mass in the pericardial fluid

During a period of 2 years, nine patients with a mean age of 69 years (range, 19 to 86) presented with acute cardiac tamponade caused by hemorrhagic pericardial effusion: myocardial rupture after myocardial infarction in 6, traumatic in 2, and aortic dissection in 1. All underwent emergency echocardiographic evaluation and had at least a moderate-sized effusion. In all nine patients a discrete echo-dense mass within the pericardial fluid was observed adjacent to the heart. Three patients died before surgery; six underwent surgery, four of whom survived the operation. Hemorrhagic pericardial effusion was found in all nine patients; the underlying diagnoses were confirmed at operation or pericardiocentesis. It was concluded that acute hemorrhage into the pericardial sac, particularly if pericardial tamponade is present, manifests itself as an echo-dense mass in the pericardial fluid suggestive of thrombus formation. The presence of this finding may help in the decision for early surgical intervention.