ABSTRACT
The pericardium is visible in each of the standard imaging planes of the heart and should therefore be examined in each view. As the normal pericardium is thin it is not prominent on echo, but may appear as a thin bright line around the heart. Cardiac tamponade refers to the haemodynamic decompensation that occurs when the pressure within a pericardial effusion compresses the heart. Use pulsed-wave Doppler to assess right and left ventricular inflow and look for the exaggerated respiratory variation seen in tamponade. Echo guidance can help determine when the pericardiocentesis needle is correctly located within the pericardium. Thickening and fibrosis of the serous pericardium can constrict the heart, like a rigid envelope, impairing filling of the ventricles in diastole and leading to equalisation of the diastolic pressures in both ventricles. Congenital absence is a rare abnormality that can affect part or all of the pericardium.
