Correct!
5. Transthoracic echocardiography
The thoracic CT shows pericardial abnormalities, and, while enhanced thoracic CT provides excellent assessment of the pericardium, echocardiography can not only evaluate the morphology of the pericardium but can assess for the function consequences of pericardial abnormalities, including pericardial tamponade or pericardial constriction. Repeat chest radiography is unlikely to reveal new, additional information to that already known from the previous chest radiograph and thoracic CT. Catheter pulmonary angiography plays a limited role in modern practice in general, typically reserved for assessment and treatment of possible pulmonary emboli, treatment of arteriovenous malformations, embolization of anomalous vessels supplying sequestrations, and several other uncommon circumstances, but has little role in the evaluation of this patient. 18FDG-PET scanning plays a large role in the evaluation of the solitary pulmonary nodule, lung cancer staging, and the staging of extrathoracic malignancies, but has little role in the evaluation of pericardial effusions- active pericardial uptake could indicate neoplasm or inflammation of practically any cause. 68Ga-citrate scintigraphy is occasionally used for the assessment of diffuse lung diseases, but generally has little value in the assessment of pleural and pericardial effusions.
Transthoracic echocardiography showed a normal ejection fraction and grossly normal valvular function, and did reveal the presence of at least a small pericardial effusion However, the echocardiogram was technically challenging and was suboptimal.
Which of the following represents the next most appropriate step for the evaluation of this patient? (Click on the correct answer to proceed to the last panel)