Marked Diastolic Collapse of the Right Atrium Without Hemodynamic Compromise Caused by a Large Pleural Effusion (2023)


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Journal of the American Society of Echocardiography

Volume 7, Issue 1,

January–February 1994

, Pages 87-88

(Video) Cardiovascular | Structures and Layers of the Heart

A 40-year-old man was seen with a large pleural effusion and marked diastolic compression of the right atrium but without physical or other echocardiographic signs of cardiac tamponade. The echocardiographic abnormality disappeared after thoracentesis.

References (9)

  • GS Kochar et al.Right atrial compression in postoperative cardiac patients: detection by transesophageal echocardiography

    J Am Coll Cardiol


  • J Torelli et al.Left atrial tamponade: diagnosis by transesophageal echocardiography

    J Am Soc Echocardiogr


  • WF Armstrong et al.

    Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study



  • LD Gillam et al.

    Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade



There are more references available in the full text version of this article.

Cited by (14)

  • An echocardiographic assessment of cardiovascular hemodynamics in patients with large pleural effusion

    2013, Indian Heart Journal

    The close relationship between pleural space and pericardial space and the dependence of their pressure kinetics are well known. This study evaluates the effects of increased intra pleural pressure due to pleural effusion on cardiovascular system.

    Forty patients above the age of 12 who had massive unilateral/bilateral pleural effusion due to non-cardiac etiology were included in the study. Therapeutic thoracocentesis was done for massive pleural effusion. The echocardiographic parameters measured before and after thoracocentesis were compared.

    Mean age of the patients 46.6 years. Out of 40 patients 8 were females (20%). 7 patients had right atrial collapse on echo. 85% of patients had significant flow velocity changes across both tricuspid valve and mitral valve during phases of respiration.11 patients (47.82%) had IVC compressibility of <50% during inspiration. Mean flow velocity respiratory variations across tricuspid valve before thoracocentesis and after thoracocentesis E 45.04 ± 10.3,32 ± 11.3% (p value <0.001), A 53.71 ± 28%, 32.08 ± 12.5% (p < 0.001) across mitral valve E 32.30 ± 12%, 19.78 ± 7.8% (p < 0.001), A 26 ± 11.2%, 21 ± 9.3% (p0.006) across pulmonary artery 42.63 ± 31.3%, 17.70 ± 6.2% (p < 0.001), across aorta 21.57 ± 11.4%, 14.08 ± 7.6% (p < 0.001).

    Large pleural effusion has a potential to cause adverse impact on the cardiovascular hemodynamics, which could manifest as tamponade physiology. Altered cardiac hemodynamics could be an important contributor in the mechanism of dyspnea in patients with large pleural effusion.

  • Pleural effusion causing cardiac tamponade: Report of two cases and review of the literature

    2006, Heart and Lung: Journal of Acute and Critical Care

    We report on two patients who developed large left-sided pleural effusions in association with hemodynamic compromise. In both cases transthoracic echocardiography demonstrated left ventricular diastolic collapse confirming our clinical suspicion of cardiac tamponade. Large-volume thoracentesis in the first case and thoracotomy with drainage of the pleural collection in the second case resulted in immediate hemodynamic improvement. Our report shows that large pleural effusions can result in impaired cardiac filling and a tamponade-like physiology. Thoracentesis in this setting can lead to rapid improvement of the hemodynamic profile.

  • Large pleural effusions producing signs of cardiac tamponade resolved by thoracentesis

    2002, American Journal of Cardiology

  • Can pleural effusions cause cardiac tamponade?

    1999, Chest

    Pleural effusion(s) can increase the pressure of an otherwise insignificant pericardial effusion to a degree that can result in cardiac tamponade. The case histories presented here illustrate the importance of recognizing this phenomenon and altering our treatment algorithm to drain the pleural effusions instead of the pericardial collections.

  • Right ventricular diastolic collapse without hemodynamic compromise in a patient with large, bilateral pleural effusions

    1995, Journal of the American Society of Echocardiography

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    A 22-year-old woman was admitted to the hospital with large bilateral pleuraleffusions and venous thromboembolism. Echocardiography revealed right ventricular diastolic collapse (RVDC) without physical signs of cardiac tamponade. This echocardiographic abnormality disappeared after thoracentesis. The results of this case report would suggest that pleural effusions were responsible for the echocardiographic finding of RVDC. Presence of RVDC in patients without clinical evidence of cardiac tamponade should alert physicians to look for pleural effusion. Echocardiographic reevaluation after thoracentesis should precede pericardiocentesis.

View all citing articles on Scopus
(Video) Cardiac Tamponade - Causes, Symptoms & Treatment.

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Copyright © 1994 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.


Why does right atrium collapse in tamponade? ›

A common sign of cardiac tamponade with significant hemodynamic compromise is collapse of the right atrium (RA) and the RV. This happens during their relaxation phase, when intra-chamber pressures are lower than pericardial pressures (26).

What is right ventricular diastolic collapse? ›

One of the earliest signs of tamponade is diastolic collapse of the right ventricle (RV), usually in early diastole, indicating that intrapericardial pressure is transiently exceeding RV filling pressure during diastole.

What are the 3 signs of cardiac tamponade? ›

A hallmark sign of cardiac tamponade is a trio of symptoms known as Beck's triad: Low blood pressure (hypotension). Bulging neck veins. Heartbeat sounds that are distant or muffled when listening through a stethoscope.

Can an echocardiogram detect pleural effusion? ›

Diagnosis of pleural effusion (PE) is generally based on chest x‐ray findings. Ultrasound is more sensitive in the detection of PE. PE is also frequently detected during echocardiographic examination.

What does diastolic collapse mean? ›

Conclusions: Left ventricular diastolic collapse is a reliable sign of regional left ventricular tamponade and is associated with a reduction in cardiac output. This echocardiographic finding usually occurs before the development of arterial hypotension and pulsus paradoxus.

What is right atrial collapse? ›

Right atrial collapse is explained by the fact that intrapericardial pressure transiently exceeds right atrial pressure, but the timing and duration of this finding are determined by the cardiac cycle, as well as respiratory cycle.


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