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  • This is a case of a peritoneal-pericardial diaphragmatic hernia with secondary compression of the right ventricle and resulting pleural and pericardial effusion. Most candidates did poorly on this case.
  • From the videoclips, you can identify a hypoechoic mass within the pericardium causing compression of the right ventricle. Immediately adjacent to the hypoechoic structure is a large hyperechoic region consistent with fat. This area (hyperechoic and hypoechoic) can be traced caudally and clearly blends in with the hepatic parenchyma.
  • There‚Äôs mild dilation of the caudal vena cava.
  • The pericardium can be seen with fluid in both the pericardial and pleural space.
  • Candidates who did poorly on this case failed to recognize the structure as hepatic. They also failed to recognize the hyperechoic region as falciform fat.
  • Many candidates attempted to make this a primary pulmonary mass or cranial mediastinal mass while ignoring the association with the pericardium and right ventricle.
  • Those candidates that were successful easily recognized the hyperechoic tissue as fat which prompted them to pay careful attention for a peritoneal pericardial diaphragmatic hernia.
  • This case tested the candidates ability to recognize thoracic anatomy in addition to having some comfort with the heart on ultrasound.