Pericardial effusion
Pericardial effusion is accumulation of fluid in the pericardial space, ranging from an incidental finding to life-threatening tamponade. Its hemodynamic effect depends on the rate of accumulation rather than volume alone, and management ranges from observation and treating the cause to pericardiocentesis for tamponade or large symptomatic effusions.
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What this article covers
- Overview
Definition: pericardial effusion is the accumulation of fluid within the pericardial space, which may be serous, hemorrhagic, purulent, or malignant.
- Epidemiology
Common, frequently found incidentally on imaging.
- Risk factors
Pericarditis (viral, autoimmune, uremic, post-cardiac injury).
- Pathophysiology
Fluid accumulation: inflammation, malignancy, or bleeding adds fluid to the pericardial space.
- Clinical features
Often asymptomatic when small or slowly accumulating.
- Differential diagnosis
Cardiac tamponade: an effusion with hemodynamic compromise, distinguished by diastolic chamber collapse and pulsus paradoxus, not a stable effusion without collapse (Cardiac tamponade).
- Diagnosis
Establish and characterize with echocardiography, assessing size and hemodynamic effect: the diagnostic basis is transthoracic echocardiography demonstrating and sizing the effusion and, critically…
- Management
First-line, stratify by hemodynamics: drain urgently by pericardiocentesis for tamponade, and treat the underlying cause for a stable effusion.
- Complications
Cardiac tamponade. Recurrent or loculated effusion.
- Prognosis
Good for small idiopathic or inflammatory effusions.
- Prevention
Treat the underlying cause to prevent progression.
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Related articles
- Cardiac tamponade
Cardiac tamponade is life-threatening compression of the heart by a pericardial effusion, impairing diastolic filling and cardiac output. It presents with hypotension, distended neck veins, and pulsus paradoxus, is confirmed by echocardiography, and is treated by urgent pericardiocentesis; avoid vasodilators and aggressive diuresis.
- Acute pericarditis
Acute pericarditis is inflammation of the pericardium, most often viral or idiopathic, presenting with pleuritic chest pain relieved by sitting forward, a pericardial friction rub, and diffuse ST elevation with PR depression. Treatment is an NSAID plus colchicine, and the main hazards are effusion, tamponade, and recurrence.
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