Pericarditis causes: Difference between revisions
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* (35%) Neoplastic | * (35%) Neoplastic | ||
* (23%) Autoimmune | * (23%) Autoimmune | ||
* (21%) Viral - [[adenovirus]], [[enterovirus | * (21%) Viral - [[adenovirus]], [[enterovirus]], [[influenza virus]] etc. | ||
* ( 6%) Bacterial (other than tuberculosis) | * ( 6%) Bacterial (other than [[tuberculosis]]) | ||
* ( 6%) [[Uremia]] | * ( 6%) [[Uremia]] | ||
* ( 4%) [[Tuberculosis]] | * ( 4%) [[Tuberculosis]] | ||
* ( 4%) Idiopathic | * ( 4%) Idiopathic | ||
* (remaining) trauma, drugs, post-AMI, [[myocarditis]], [[dissecting aortic aneurysm]], [[radiation]] | * (remaining) [[trauma]], drugs, [[Dresslers' syndrome|post-AMI]], [[myocarditis]], [[dissecting aortic aneurysm]], [[radiation]] | ||
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|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |Post-MI ([[Dresslers]]), [[Dissecting aortic aneurysm]] | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |Post-MI ([[Dresslers]]), [[Dissecting aortic aneurysm]], underlying [[myocarditis]] | ||
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*'''Purulent:''' [[Pneumococcus]], [[Streptococcus]] and [[Staphylococcus]] most common. Also Proteus, [[E.coli]], Psuedomonas, [[Klebsiella]], [[Brucellosis]], [[Salmonella]], [[Neisseria]], [[Haemophilus influenza]], [[Tularemia]], [[Legionella]], preodominantly by hematogenous spread and approximately 20% by contiguous spread. Usually these patients are quite ill. | *'''Purulent:''' [[Pneumococcus]], [[Streptococcus]] and [[Staphylococcus]] most common. Also Proteus, [[E.coli]], Psuedomonas, [[Klebsiella]], [[Brucellosis]], [[Salmonella]], [[Neisseria]], [[Haemophilus influenza]], [[Tularemia]], [[Legionella]], preodominantly by hematogenous spread and approximately 20% by contiguous spread. Usually these patients are quite ill. | ||
*'''Fungal:''' [[Histoplasmosis]], [[Coccidiomycosis]], [[Aspergillus]], [[Blastomycosis]], [[Candida]]. | *'''Fungal:''' [[Histoplasmosis]], [[Coccidiomycosis]], [[Aspergillus]], [[Blastomycosis]], [[Candida]]. | ||
*'''Other:''' [[ | *'''Other:''' [[Actinomycosis]], [[Amebiasis]], [[Borrelia]], [[Echinococcus]], [[Lyme disease]] (usually myopericarditis associated with conduction abnormalities)[[Mycoplasma]], [[Nocardia]], [[Toxoplasmosis]]. | ||
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| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"|Predominantly lung, breast, [[leukemia]], [[lymphomas]] ([[Hodgkins]] and non-Hodgkins). Less commonly GI malignancies, [[ovarian cancer]], [[sarcoma]]s and [[melanoma]]s, metastic, hematogenous, [[carcinoma]], [[carcinoid]], [[Sipple syndrome]], [[mesothelioma]], [[fibroma]], [[lipoma]] . Also [[Kaposis sarcoma]] in [[HIV]] positive patients. | |bgcolor="Beige"|Predominantly [[lung cancer]], [[breast cancer]], [[leukemia]], [[lymphomas]] ([[Hodgkins]] and non-Hodgkins). Less commonly GI malignancies, [[ovarian cancer]], [[sarcoma]]s and [[melanoma]]s, metastic, hematogenous, [[carcinoma]], [[carcinoid]], [[Sipple syndrome]], [[mesothelioma]], [[fibroma]], [[lipoma]] . Also [[Kaposis sarcoma]] in [[HIV]] positive patients. | ||
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|bgcolor="Beige"|*[[Systemic Lupus Erythematosus]] or [[SLE]]: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate ([[ESR]]) , +ANA, +dsDNA, [[pleural effusion]]s). Occurs in 20-40% of patients with [[SLE]] during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically [[WBC]] count is less than 10K, and is made up of primarily [[polymorphonuclear cell]]s ([[PMN]]s). | |bgcolor="Beige"|*[[Systemic Lupus Erythematosus]] or [[SLE]]: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate ([[ESR]]) , +ANA, +dsDNA, [[pleural effusion]]s). Occurs in 20-40% of patients with [[SLE]] during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically [[WBC]] count is less than 10K, and is made up of primarily [[polymorphonuclear cell]]s ([[PMN]]s). | ||
*[[Rheumatoid arthritis]] or [[RA]]: Pericarditis can occur without active joint involvement. Also serous or bloody. Usually the protein is > 5 mg/dl, and the glucose is low (<45). The [[WBC]] is high at 20-90K. Complement is usually low, and the latex fixation test is usually positive. | *[[Rheumatoid arthritis]] or [[RA]]: Pericarditis can occur without active joint involvement. Also serous or bloody. Usually the protein is > 5 mg/dl, and the glucose is low (<45). The [[WBC]] is high at 20-90K. Complement is usually low, and the latex fixation test is usually positive. | ||
*Other: Acute [[rheumatic fever]], [[scleroderma]], mixed [[connective tissue disease]], [[Wegener's]], [[PAN]], [[temporal arteritis]] and [[Behcet syndrome]]. | *Other: Acute [[Ankylosing Spondylitis]],[[rheumatic fever]], [[scleroderma]], mixed [[connective tissue disease]], [[Wegener's]], [[PAN]], [[temporal arteritis]] and [[Behcet syndrome]]. | ||
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Revision as of 14:32, 16 July 2011
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Pericarditis causes On the Web |
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American Roentgen Ray Society Images of Pericarditis causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pericarditis can present as a disorder primarily involving the pericardium (e.g viral etiologies), as manifestation of a systemic illness (e.g. autoimmune illnesses), or as a manifestation of a disorder involving an adjacent anatomic structure (e.g. cancer).
Common Causes of Pericarditis [1]
- (35%) Neoplastic
- (23%) Autoimmune
- (21%) Viral - adenovirus, enterovirus, influenza virus etc.
- ( 6%) Bacterial (other than tuberculosis)
- ( 6%) Uremia
- ( 4%) Tuberculosis
- ( 4%) Idiopathic
- (remaining) trauma, drugs, post-AMI, myocarditis, dissecting aortic aneurysm, radiation
Complete Differential Diagnosis of the Causes of Pericarditis
(By organ system)
| Cardiovascular | Post-MI (Dresslers), Dissecting aortic aneurysm, underlying myocarditis |
| Chemical / poisoning | No underlying causes |
| Dermatologic | Behcet syndrome |
| Drug Side Effect | Usually associated with small effusions. Common culprits include hydralazine, procainamide, DOH, isoniazid, phenylbutazone, dantrolene, doxorubicin, methylsergide, penicillin. |
| Ear Nose Throat | Temporal arteritis |
| Endocrine | Usually in conjunction with clinically severe hypothyroidism. Most early case reports associated with myxedema and patients also had ascites, pleural effusions and uveal edema. Often resolves with thyroid replacement therapy. A pericardial effusion can be seen as part of an Addisonian crisis. |
| Environmental | No underlying causes |
| Gastroenterologic | Inflammatory bowel disease, Whipple's |
| Genetic | No underlying causes |
| Hematologic | Leukemia, Lymphoma |
| Iatrogenic | Post-pericardiotomy syndrome,Radiation therapy, Chylopericardium (from thoracic duct obstruction secondary to tumor, surgical procedure. |
| Infectious Disease | *Viral: Coxsackie B Virus, Echovirus, Adenovirus (less commonly: Mumps, Influenza, varicella, Hepatitis B and CMV-especially in HIV patients.) Usually associated with a viral prodrome and acute pericarditis.
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| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Predominantly lung cancer, breast cancer, leukemia, lymphomas (Hodgkins and non-Hodgkins). Less commonly GI malignancies, ovarian cancer, sarcomas and melanomas, metastic, hematogenous, carcinoma, carcinoid, Sipple syndrome, mesothelioma, fibroma, lipoma . Also Kaposis sarcoma in HIV positive patients. |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Sarcoidosis |
| Renal / Electrolyte | Uremic pericarditis is seen in up to 20% of uremic patients requiring chronic hemodialysis. The mechanism is unknown. Most commonly there is a small effusion associated with pain and a pericardial friction rub, but there can be a large effusion and present with tamponade |
| Rheum / Immune / Allergy | *Systemic Lupus Erythematosus or SLE: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate (ESR) , +ANA, +dsDNA, pleural effusions). Occurs in 20-40% of patients with SLE during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically WBC count is less than 10K, and is made up of primarily polymorphonuclear cells (PMNs).
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| Sexual | No underlying causes |
| Trauma | After chest trauma, throacic surgery, PCM insertion, Valvuloplasty. Also from esophageal rupture, pancreatic-pericardial fistula (check amylase), penetrating chest injury, esophogeal perforation, gastric perforation, during catheterization (pacemaker insertion, cathether ablation for arrhythmias, diagnostic, PCI with coronary dissection). |
| Urologic | No underlying causes |
| Miscellaneous | Amyloidosis, commonly the diagnosis is idiopathic. |
Differential Diagnosis of Causes of Acute Pericarditis
In alphabetical order:
- Actinomycosis
- Acute idiopathic pericarditis
- Acute rheumatic fever
- Adenovirus
- Addison's crisis
- Amyloidosis
- Amebiasis
- Ankylosing Spondylitis
- Aortic dissection
- Behcet's Disease
- Borrelia
- Breast cancer
- Chylopericardium
- Coxsackie A
- Coxsackie B
- Cytomegalovirus
- Dermatomyositis
- Dermatosclerosis
- Dressler's Syndrome
- EBV
- ECHO virus
- Echinococcosis
- Familial Mediterranian Fever
- Francisella
- HIV
- Infectious mononucleosis
- Inflammatory Bowel Disease
- Influenza virus
- Legionella
- Leukemia
- Lung cancer
- Lymphoma
- Meningococci
- Mixed Connective Tissue Disease
- Mumps virus
- Mycoplasma infection
- Neisseria gonorrhoeae
- Perforated esophagus
- Pneumococci
- Polyarteritis Nodosa
- Polymyositis
- Postpericardiotomy syndrome
- Reiter's Syndrome
- Radiation therapy
- Renal Failure
- Rheumatoid Arthritis
- Rickettsia
- Sarcoidosis
- Scleroderma
- Serum sickness
- Staphylococci
- Streptococci
- Systemic Lupus Erythematosus
- Thorax trauma
- Treponema pallidum
- Toxoplasmosis
- Tuberculosis
- Uremia
- Varicella virus
- Wegener's granulomatosis
- Whipple's Disease
Differential Diagnosis of Causes of Chronic Pericarditis
In alphabetical order:
- Amebiasis
- Bacterial infections
- Cholesterol pericarditis
- Chylopericardium
- Coccidioidomycosis
- Collagen Vascular Disease
- Coxsackie B
- Echinococcosis
- Histoplasmosis
- Neoplastic pericarditis
- Tuberculosis
- Uremic pericarditis
References
- ↑ Maisch B, Ristic AD (2002). "The classification of pericardial disease in the age of modern medicine". Curr Cardiol Rep. 4 (1): 13–21. doi:10.1007/s11886-002-0121-6. PMID 11743917.