Epicardial halo phenomenon: a guide for pericardiocentesis?

Area of Science:

• Cardiology
• Medical Imaging

Background:

• The epicardial halo is a fluoroscopic sign delineating the heart shadow.
• Its utility in guiding pericardiocentesis requires evaluation.

Purpose of the Study:

• To assess the applicability of the epicardial halo sign for pericardiocentesis guidance.
• To determine the sensitivity and correlation of the halo sign with pericardial effusion (PE) characteristics.

Main Methods:

• Three investigators graded halo intensity in posterior-anterior (PA) and lateral fluoroscopies of 32 PE patients, 14 perimyocarditis (PM) patients, and 46 coronary artery disease (CAD) patients.
• Correlations with heart rate (HR), echocardiographic PE size, body mass index (BMI), and age were analyzed.
• Halo sign evaluation was repeated after PE drainage in a subset of patients.

Main Results:

• Halo intensity was highest in PE patients, intermediate in PM patients, and lowest in CAD patients (p < 0.01).
• The sign correlated with HR and echocardiographic PE size, and in specific views, with BMI, age, and PE volume.
• Sensitivity for PE detection was 84.1% (PA) and 92.0% (lateral); intensity decreased significantly after PE drainage (p < 0.01).

Conclusions:

• The epicardial halo sign demonstrates high sensitivity for detecting pericardial effusion.
• It correlates with PE volume and echocardiographic findings, suggesting its potential as a safety guide for pericardiocentesis.