EchoBridgeMD Pearl #32: Pericardial Fat Pad vs Pericardial Effusion
A pericardial fat pad can mimic a pericardial effusion on echocardiography, but several features can help distinguish them.
Pericardial fat typically has a stippled or heterogeneous appearance, is commonly located anteriorly in the atrioventricular groove, and adheres to the myocardium. As a result, it moves in synchrony with the heart throughout the cardiac cycle.
In contrast, a pericardial effusion is usually anechoic and tends to collect in dependent portions of the pericardial space. Because the fluid occupies the pericardial space rather than adhering to the myocardium, its apparent thickness may increase and decrease as the adjacent cardiac chamber contracts and expands.
At the bedside: Before diagnosing a pericardial effusion, ask three questions: Where is it? What does it look like? How does it move? A stippled structure that remains adherent to and moves with the myocardium should raise suspicion for pericardial fat rather than fluid.
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📖 Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med. 2022.
📖 Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med. 2019.
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