Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Accuracy/ reliability?

Forum: The Heart Forum
Topic: Echocardiography


My 67-yr-old mother recently had an echocardiogram, EKG, and stress test as part of a general workup in preparation for hip replacement surgery. The EKG and stress test ("medication induced") were normal, but the echocardiogram showed a "small amount of fluid around the heart". I am wondering how accurate and/or reliable echocardiograms are in detecting fluid around the heart (pericardial effusion, I believe it is called)? Her chest xray (~one month earlier) had shown no evidence of fluid around the heart. Her doctor said that he would like her to have another echo in about 3 months, but gave no further details. Also, the surgery is still scheduled for later this month. I am wondering if it might not be a good idea to have a second echo prior to the surgery to make sure that the pericardial effusion IS actually a small amount. Again, my concern is the degree of accuracy or reliability of echocardiograms, especially in the detection of pericardial effusion. Thank you very much for any information or suggestions you can provide.

Sincerely,
J.M.

Dear J.M.,

The echocardiogram is the most accurate test available for detecting fluid around the
heart (you are correct that such fluid is termed "pericardial effusion"). Other studies, such as
MRI of the heart are also quite sensitive in detecting fluid, but for all practical purposes,
the echo is much more available, cost-efficient, and simpler to perform. Although quite
accurate, the echo is not infallible as occasionally, small amounts of fatty tissue around
the heart may look like fluid, when there is in actuality no significant fluid collection present.

In any case, a small amount of pericardial fluid, or effusion, is a non-specific finding. This
can have many causes, and is likely benign. It is prudent to reexamine this in a followup
echo for the purposes of documenting any increase in the amount of fluid. Such an increase
might prompt an investigation into the underlying causes of the fluid collection. Finally, a
small amount of pericardial fluid should have no impact on the outcome of hip, or other,
surgery.

Best of luck. Information in the Heart Forum is for general medical purposes. Specific diagnoses and therapies can only be provided by your physician.



[The Heart Forum]      [The Heart Forum Archives]