Pericardial Effusion

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Contents 1 Etiology 2 Pathology 3 Clinical-manifestations 4 Diagnostic-procedures 5 Radiology 6 Complications 7 Management 8 More General Terms 9 Additional Terms 10 References

Etiology

• idiopathic
• infection ( bacterial, viral, fungal, parasitic)
• trauma
• hemorrhage into the pericardial space

• trauma, myocardial infarction, aortic rupture, CABG

• cancer
• radiation therapy
• renal failure
• autoimmune disorders

• hypothyroidism
• inflammatory bowel disease
• rheumatoid arthritis

Pathology

• response of the pericardium to inflammation

• accumulation of fluid between the pericardial layers

• exudation of fluid, fibrin & blood cells
• pericardial sac distends with slow accumulation of fluid
• rapid accumulaton of only small amounts of fluid, especially with bleeding, may result in pericardial tamponade
• decreased ventricular volume & cardiac output

Clinical-manifestations

• dyspnea
• chest pain
• tachycardia
• jugular venous distension ( JVD)
• pulsus paradoxus

Diagnostic-procedures

• electrocardiogram

Radiology

• chest X-ray

• 250 mL of pericardial effusion necessary before it can be seen on chest x-ray

• echocardiogram

• ultrasound guided pericardiocentesis if indicated

Complications

• cardiac tamponade (7-10%) [2]

Management

• most cases can be managed with a combination of drugs

• non-steroidal anti-inflammatory agents
• glucocorticoids
• colchicine
• diuretics

• pericardiocentesis may be therapeutic as well as diagnostic
• pericardectomy may be required if constriction of the heart is severe or persists

More General Terms

• pericardial disease

Additional Terms

• cardiac tamponade
• pericarditis
• pericardium

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 51
2. Zeller JL et al, Pericardial effusion JAMA 2007, 297:1844
3. Roy CL et al, Does this patient with a pericardial effusion have a cardiac tamponade? JAMA 2007, 297:1810

pericardial effusion