Pericardial effusion differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Overview

Most pericardial effusions are caused by inflammation of the pericardium, a condition called pericarditis. As the pericardium becomes inflamed, extra fluid is produced, leading to a pericardial effusion. Viral infections are one of the main causes of pericarditis and pericardial effusions. Infections causing pericardial effusions include cytomegalovirus, coxsackie virus, echovirus, and HIV. However, other conditions like injury to the pericardium or heart from a medical procedure, myocardial infarction, uremia, autoimmune disease and cancer should be considered in differential diagnosis of pericardial effusion.

Differentiating Pericardial Effusion from other Diseases

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication and the signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds. There are several other cardiac insults with similar symptoms that should be considered in differential diagnosis of pericardial effusion.

Differential Diagnosis by Organ System

Cardiovascular	Cathether ablation for arrhythmias, coronary artery bypass grafting, dissecting aortic aneurysm, Dresslers syndrome, endocarditis, myocarditis, pacemaker insertion, percutaneous coronary intervention, postpericardiotomy syndrome, TAVI, thoracic surgery, valvuloplasty
Chemical / poisoning	Silicosis
Dermatologic	Behcet syndrome
Drug Side Effect	Dantrolene, doxorubicin, hydralazine, isoniazid, penicillin, phenylbutazone, procainamide
Ear Nose Throat	Temporal arteritis
Endocrine	Addisonian crisis, Severe hypothyroidism (myxedema)
Environmental	No underlying causes
Gastroenterologic	Inflammatory bowel disease, Whipple's
Genetic	Gaucher disease, Jacobs arthropathy-camptodactyly syndrome, Mulibrey nanism syndrome, recurrent hereditary polyserositis
Hematologic	Leukemia, lymphoma
Iatrogenic	Cardiopulmonary resuscitation, postpericardiotomy syndrome, radiation therapy, serum sickness, thoracic duct obstruction secondary to tumor, surgery
Infectious Disease	Adenovirus, alveolar hydatid disease, amebiasis, aspergillus, blastomycosis, candida, cytomegalovirus, coccidiomycosis, echinococcus, coxsackie B Virus, escherichia coli, Ebstein-Barr virus, echovirus, entamoeba histolytica, francisella, haemophilus influenza, hepatitis B, histoplasmosis, influenza, klebsiella, legionella, Lyme disease, meningococci, mumps, mycoplasma pnuemonia, neisseria, nocardia, pneumococcus, proteus, pseudomonas, rickettsia, salmonella, staphylococcus borrelia,brucellosis, streptococcus, toxoplasmosis, tuberculous, tularemiaactinomycosis, varicella
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Breast cancer, carcinoid, fibroma, kaposis sarcoma, leukemia, lipoma, lung cancer, lymphomas, mesothelioma, ovarian cancer, sarcomamelanoma, Sipple syndrome
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis
Renal / Electrolyte	Uremia
Rheum / Immune / Allergy	Systemic Lupus Erythematosus, rheumatoid arthritis, amyloidosis, ankylosing Spondylitis, Behcet syndrome, Kawasaki disease, mixed connective tissue disease, polyarteritis nodosa, polymyositis, Reiter's Syndrome, acute rheumatic fever, sarcoidosis, scleroderma, Still's disease, systemic sclerosis, temporal arteritis, Wegener's
Sexual	Neisseria gonorrhoeae, treponema pallidum
Trauma	Blunt or penetrating chest trauma, esophageal rupture, esophogeal perforation, gastric perforation, pancreatic-pericardial fistula
Urologic	Renal Failure, Uremia
Miscellaneous	Idiopathic