The phenomenon described here of a rapid diastolic collapse
of the cervical veins swelling gradually in systole has already been mentioned by other observers, and Skoda regards this rare symptom as a sign of paralysis of the right atrium, though it is difficult to see how it should arise in the latter state.
2 D echo showed massive pericardial effusion measuring 35 mm posteriorly and 23 mm anteriorly causing diastolic collapse
A 2D echocardiogram revealed cardiac tamponade with right ventricular diastolic collapse, with a large fibrinous exudative pericardial effusion (Figure 2).
Caption: Figure 2: 2D echocardiogram image of cardiac tamponade with right ventricular diastolic collapse and a large fibrinous exudative pericardial effusion.
Transthoracic echocardiogram (TTE) was performed which revealed that the effusion increased by greater than one centimeter since the most recent echocardiogram nine days prior and was now large and circumferential with early right ventricular diastolic collapse concerning for tamponade physiology (Figures 2 and 3).
Caption: Figure 2: RA diastolic collapse prior to pericardiocentesis.
Considering that the culprit vessel was too small to have a significant influence, echocardiography was performed immediately, which revealed a moderate pericardial effusion with the diastolic collapse
of cardiac chambers [Figure 1]c.
Right ventricular and right atrial diastolic collapse
were not visualized.
Echocardiography demonstrated a moderate pericardial effusion, unusual epicardial deposits consistent with tumor or thrombus overlying much of the right ventricle and right atrium, and diastolic collapse
of the right ventricle consistent with cardiac tamponade (Fig.