CTICasesPericardial Effusion (Epicardial Fat Pad Sign)
Imaging findings
A frontal chest radiograph shows an enlarged cardiac silhouette with the right heart border not markedly convex, plus a central hypoattenuating stripe with a surrounding halo of increased attenuation producing an Oreo cookie / epicardial fat pad sign. After drainage, the right heart border returns to a normal expected curvature.
Key takeaways
A pericardial effusion can be recognized on a frontal radiograph by the epicardial fat pad (Oreo cookie) sign, a lucent stripe of pericardial fat separated from the surrounding higher-attenuation soft tissue, with the enlarged cardiac silhouette lacking the discrete chamber convexities of true cardiomegaly. Post-drainage restoration of a normal cardiac contour confirms the diagnosis.
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