Detection of pericardial metastases by cross-section echocardiography.

Cross-sectional echocardiography was performed on 69 patients with pericardial effusion. The etiology of the pericardial effusion was malignant infiltration of the pericardium in nine patients; chronic renal failure in 10; postcardiac surgery in 31; viral pericarditis in three; tuberculous pericarditis in two; and undetermined in 14. Seven of the nine patients with pericardial metastases were noted to have irregular cauliflower-like masses protruding from the pericardium and the epicardium into the echo-free space of the pericardial effusion. These masses demonstrated a to-and-fro motion within the pericardial space during ventricular systole. The presence of pericardial metastases was confirmed at operation in four cases and the three others had intrathoracic or colonic malignancy with widespread metastases. None of the patients without pericardial metastasis showed the characteristic abnormality seen in patients with pericardial metastases. Six patients had dense linear echoes connecting the pericardium and epicardium that probably represented adhesions (confirmation at surgery in one, and confirmation at autopsy in another), with an appearance that was different from that seen in pericardial metastases. We conclude that cross-sectional echocardiography may be useful for detecting pericardial metastases.