Abscesses

Rarely abscesses may involve the pericardial sac. They appear to have thin walls with large hypoechoic areas within them and are adhered to the pericardial sac instead of the heart as other cardiac masses are. Large abscesses may compress the cardiac chamber next to it (168).

Pericardial Cysts

Fluid-filled cystic structures within the pericardial sac have occasionally been reported in the dog and cat (169–172). The cyst may be loculated, and some have been attached to the parietal pericardium by a stalk. An association with pericardial peritoneal diaphragmatic hernia is reported in several cases, and it is hypothesized that abdominal viscera become confined into the pericardial space in conjunction the hernia. Echocardiographically a large fluid-filled space or spaces are seen within the pericardial sac. These cystic structures may elevate intrapericardial pressure resulting compression of cardiac chambers and possibly tamponade (173).

Thrombus

Organized thrombi appear as free-floating layers or strands of echogenic material within the pericardial space. This may be seen secondary to acute bleeding from hemangiosarcoma, ruptured atrium, idiopathic hemorrhagic effusion, or after a pericardiocentesis if the heart was penetrated (Figures 5.22, 5.23) (85,174). While thrombus occurrences within the cardiac chambers are ball or oval shaped, soft tissue structures found within the pericardial sac are almost always neoplasia of some sort and are not typical of thrombus within the sac. Read more about thrombus in the heart in Chapter 7.

Bleeding into the pericardial sac results in long layers of organized clot.

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