Patient was a 72 y/o male with no known history, who was brought in to the ED as a MVC trauma. In the field, paramedics had not heard breath sounds on the right pleural fields, so they performed an emergent thoracocentesis for possible pneumothorax.
Upon arrival to the ED, we performed a FAST scan and noted significant fluid in the R3 lung space, a B profile in R2 and R1, as well as a moderate pericardial effusion. It is sometimes difficult to tell whether a visualized fluid collection beneath the heart is in the pericardial vs the posteromedial pleural cavity. If the fluid collection is above the aorta, it is a pericardial effusion; if it is below the aorta, it is a pleural effusion. It is important to remember that things like fat pads, pericardial cysts, or a pre-existing chronic pericardial effusion could be mistaken for an acute hemopericardium. (1)
A chest tube was placed, and approximately 300mL blood drained even before suction was attached.
1. Richards, J. R.; McGahan, J.P. “Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn.” https://pubs.rsna.org/doi/full/10.1148/radiol.2017160107.