Liver flow and cardiac tamponade

Q: How hepatic venous flow abnormalities can help in the diagnosis of pericardial tamponade?

Answer: 

Using abdominal ultrasound in cardiac tamponade help in two ways.

1. Hepatic: Although it can be seen only in one-third of patients, hepatic venous flow abnormalities have a high positive (82%) and negative (88%) predictive values for cardiac tamponade. It is seen as

• blunting or frank reversal of diastolic flow with expiration, and 
• systolic venous flow predominance

2. Inferior Vena Cava (IVC) plethora: Dilatation and less than a 50 percent reduction in the diameter of the dilated IVC during inspiration, reflects a marked elevation in central venous pressure (CVP). If an IVC plethora is present with pulses paradoxus, there is more than a 90% probability that a patient will require pericardial drainage. Unfortunately, though it is a highly sensitive sign but has no specificity.

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References:

1. Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, et al. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J 1999; 138:759. 


2.  Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol 1988; 12:1470.