ISRAEL STEINBERG, M.D., F.A.C.P.
Recent observations following angiocardiography in patients with pericardial effusions reaffirm that small effusions accumulate in the infracardiac diaphragmatic portion of the pericardial sac. With larger effusions, the fluid next accumulates anteriorly in the retrosternal area because of fixation of the pericardium to the great vessels above, and by the inferior vena cava as it pierces the diaphragm below. With massive effusions, the lateral pericardial pouches become distended. In light of this information, a note concerning Ewart's sign and thoracic paracentesis through the posterior approach seems warranted.
Ewart in 1896,1 and Pins2 before him, called attention to the presence of an
STEINBERG I. PERICARDITIS WITH EFFUSION: NEW OBSERVATIONS, WITH A NOTE ON EWART'S SIGN12. Ann Intern Med. ;49:428–437. doi: 10.7326/0003-4819-49-2-428
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Published: Ann Intern Med. 1958;49(2):428-437.
Cardiology, Pericardial Disease.
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