Pericardial effusion differential diagnosis: Difference between revisions

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Revision as of 08:06, 2 March 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mugilan Poongkunran M.B.B.S [2]; Cafer Zorkun, M.D., Ph.D. [3]; 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.

Diseases	CT scan and MRI	EKG	Chest X-ray	Tachypnea	Tachycardia	Fever	Chest Pain	Hemoptysis	Dyspnea on Exertion	Wheezing	Chest Tenderness	Nasalopharyngeal Ulceration	Carotid Bruit	Past medical history	Other Findings
Diseases	Diagnostic tests			Physical Examination			Symptoms							Past medical history	Other Findings
Pulmonary embolism	On CT angiography: Intra-luminal filling defect On MRI: Narrowing of involved vessel No contrast seen distal to obstruction Polo-mint sign (partial filling defect surrounded by contrast)	S1Q3T3 pattern representing acute right heart strain	Fleischner sign (enlarged pulmonary artery), Hampton hump, Westermark's sign	✔	✔	✔ (Low grade)	✔	✔ (In case of massive PE)	✔	-	-	-	-	Hypercoagulating conditions (Factor V Leiden, thrombophilia, deep vein thrombosis, immobilization, malignancy, pregnancy)	May be associated with metabolic alkalosis and syncope
Congestive heart failure	On CT scan: Mediastinal lymphadenopathy Hazy mediastinal fat On MRI: Abnormality of cardiac chambers (hypertrophy, dilation) Delayed enhancement MRI may help characterize the myocardial tissue (fibrosis) Late enhancement of contrast in conditions such as myocarditis, sarcoidosis, amyloidosis, Anderson-Fabry's disease, Chagas disease)	Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity) SV1 or SV2 + RV5 or RV6 ≥3.5 mV Total QRS amplitude in each of the limb leads ≤0.8 mV R/S ratio <1 in lead V4	Cardiomegaly	✔	✔	✔	-	-	✔	-	-	-	-	Previous myocardial infarction Hypertension (systemic and pulmonary) Cardiac arrythmias Viral infections (myocarditis) Congenital heart defects	Right heart failure associated with: Hepatomegaly Positive hepato-jugular reflex Increased jugular venous pressure Peripheral edema Left heart failure associated with: Pulmonary edema Eventual right heart failure
Percarditis	On contrast enhanced CT scan: Enhancement of the pericardium (due to inflammation) Pericardial effusion Pericardial calcification On gadolinium-enhanced fat-saturated T1-weighted MRI: Pericardial enhancement (due to inflammation) Pericardial effusion	ST elevation PR depression	Large collection of fluid inside the pericardial sac (pericardial effusion) Calcification of pericardial sac	✔	✔	✔ (Low grade)	✔ (Relieved by sitting up and leaning forward)	-	✔	-	-	-	-	Infections: Viral (Coxsackie virus, Herpes virus, Mumps virus, HIV) Bacteria (Mycobacterium tuberculosis-common in developing countries) Fungal (Histoplasmosis) Idiopathic in a large number of cases Autoimmune Uremia Malignancy Previous myocardial infarction	May be clinically classified into: Acute (< 6 weeks) Sub-acute (6 weeks - 6 months) Chronic (> 6 months)
Pneumonia	On CT scan: (not generally indicated) Consolidation (alveolar/lobar pneumonia) Peribronchial nodules (bronchopneumonia) Ground-glass opacity (GGO) Abscess Pleural effusion On MRI: Not indicated	Prolonged PR interval Transient T wave inversions	Consolidation (alveolar/lobar pneumonia) Peribronchial nodules (bronchopneumonia) Ground-glass opacity (GGO)	✔	✔	✔	✔	-	✔	✔	-	-	-	Ill-contact Travelling Smoking Diabetic Recent hospitalization Chronic obstructive pulmonary disease	Requires sputum stain and culture for diagnosis Empiric management usually started before culture results
Vasculitis	On CT scan: (Takayasu arteritis) Vessel wall thickening Luminal narrowing of pulmonary artery Masses or nodules (ANCA-associated granulomatous vasculitis) On MRI: Homogeneous, circumferential vessel wall swelling	Right or left bundle-branch block (Churg-Strauss syndrome) Atrial fibrillation (Churg-Strauss syndrome) Non-specific ST segment and T wave changes	Nodules Cavitation	✔	✔	✔	✔	✔	✔	-	✔	✔	✔	Takayasu arteritis usually found in persons aged 4-60 years with a mean of 30 Giant-cell arteritis usually occurrs in persons aged > 60 years Churg-Strauss syndrome may present with asthma, sinusitis, transient pulmonary infiltrates and neuropathy alongwith cardiac involvement Granulomatous vasculitides may present with nephritis and upper airway (nasopharyngeal) destruction
Chronic obstructive pulmonary disease (COPD)	On CT scan: Chronic bronchitis may show bronchial wall thickening, scarring with bronchovascular irregularity, fibrosis Emphysema may show alveolar septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe) Giant bubbles On MRI: Increased diameter of pulmonary arteries Peripheral pulmonary vasculature attentuation Loss of retrosternal airspace due to right ventricular enlargement Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung	Multifocal atrial tachycardia (atleast 3 distinct P wave morphologies)	Enlarged lung shadows (emphysema) Flattening of diaphragm (emphysema)	✔	✔	-	-	-	✔	✔	-	-	-	Smoking Alpha-1 antitrypsin deficiency Increased sputum production (chronic bronchitis) Cough	Alpha 1 antitrypsin deficiency may be associated with hepatomegaly

References

Template:WikiDoc Sources

@@ Line 10: / Line 10: @@
 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===
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
- {|style="width:80%; height:100px" border="1"
+! rowspan="2" |<small>Diseases</small>
-|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
+! colspan="3" |<small>Diagnostic tests</small>
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Catheter ablation|Cathether ablation for arrhythmias]], [[CABG|coronary artery bypass grafting]], [[dissecting aortic aneurysm]], [[Dresslers syndrome]], [[endocarditis]], [[myocarditis]], [[pacemaker|pacemaker insertion]], [[percutaneous coronary intervention]], [[postpericardiotomy syndrome]], [[TAVI]], [[thoracic surgery]], [[valvuloplasty]]
+! colspan="3" |<small>Physical Examination</small>
+| colspan="7" |<small>Symptoms
+! colspan="1" rowspan="2" |<small>Past medical history</small>
+! rowspan="2" |<small>Other Findings</small>
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!<small>CT scan and MRI</small>
+!<small>EKG</small>
+!<small>Chest X-ray</small>
+!<small>Tachypnea</small>
+!<small>Tachycardia</small>
+!<small>Fever</small>
+!<small>Chest Pain</small>
+!<small>Hemoptysis</small>
+!<small>Dyspnea on Exertion</small>
+!<small>Wheezing</small>
+!<small>Chest Tenderness</small>
+!<small>Nasalopharyngeal Ulceration</small>
+!<small>Carotid Bruit</small>
 |-
-|-bgcolor="LightSteelBlue"
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Pulmonary_embolism Pulmonary embolism]
-| '''Chemical / poisoning'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"| [[Silicosis]]
+*On [https://www.wikidoc.org/index.php/CT_angiography CT angiography]:
+**Intra-luminal filling defect
+*On [https://www.wikidoc.org/index.php/MRI MRI]:
+**Narrowing of involved [https://www.wikidoc.org/index.php/Blood_vessel vessel]
+**No contrast seen distal to [https://www.wikidoc.org/index.php/Obstruction obstruction]
+**Polo-mint sign (partial filling defect surrounded by contrast)
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Pulmonary_embolism_electrocardiogram S1Q3T3] pattern representing acute [https://www.wikidoc.org/index.php/Right_heart right heart] strain
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Fleischner_sign Fleischner sign] (enlarged pulmonary artery), [https://www.wikidoc.org/index.php/Hampton's_hump Hampton hump], [https://www.wikidoc.org/index.php/Westermark's_sign Westermark's sign]
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔ (In case of massive PE)
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
+*Hypercoagulating conditions ([https://www.wikidoc.org/index.php/Factor_V_Leiden Factor V Leiden], [https://www.wikidoc.org/index.php/Thrombophilia thrombophilia], [https://www.wikidoc.org/index.php/Deep_vein_thrombosis deep vein thrombosis], immobilization, [https://www.wikidoc.org/index.php/Malignancy malignancy], [https://www.wikidoc.org/index.php/Pregnancy pregnancy])
+| style="background: #F5F5F5; padding: 5px;" |
+*May be associated with [https://www.wikidoc.org/index.php/Metabolic_alkalosis metabolic alkalosis] and [https://www.wikidoc.org/index.php/Syncope syncope]
 |-
-|-bgcolor="LightSteelBlue"
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Congestive_heart_failure Congestive heart failure]
-| '''Dermatologic'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"|[[Behcet syndrome]]<ref name="pmid420242">{{cite journal| author=Scarlett JA, Kistner ML, Yang LC| title=Behçet's syndrome. Report of a case associated with pericardial effusion and cryoglobulinemia treated with indomethacin. | journal=Am J Med | year= 1979 | volume= 66 | issue= 1 | pages= 146-8 | pmid=420242 | doi= | pmc= | url= }} </ref>
+*On [https://www.wikidoc.org/index.php/Computed_tomography CT scan]:
+**[https://www.wikidoc.org/index.php/Mediastinal_lymphadenopathy Mediastinal lymphadenopathy]
+**Hazy [https://www.wikidoc.org/index.php/Mediastinal mediastinal] fat
+*On [https://www.wikidoc.org/index.php/Magnetic_resonance_imaging MRI]:
+**Abnormality of [https://www.wikidoc.org/index.php/Cardiac cardiac] chambers ([https://www.wikidoc.org/index.php/Hypertrophy_(medical) hypertrophy], dilation)
+**Delayed enhancement [https://www.wikidoc.org/index.php/MRI MRI] may help characterize the [https://www.wikidoc.org/index.php/Myocardial myocardial] [https://www.wikidoc.org/index.php/Tissue_(biology) tissue] ([https://www.wikidoc.org/index.php/Fibrosis fibrosis])
+**Late enhancement of contrast in conditions such as [https://www.wikidoc.org/index.php/Myocarditis myocarditis], [https://www.wikidoc.org/index.php/Sarcoidosis sarcoidosis], [https://www.wikidoc.org/index.php/Amyloidosis amyloidosis], [https://www.wikidoc.org/index.php/Anderson-Fabry_disease Anderson-Fabry]'s disease, [https://www.wikidoc.org/index.php/Chagas_disease Chagas disease])
+| style="background: #F5F5F5; padding: 5px;" |
+*Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
+**[https://www.wikidoc.org/index.php/S_wave S]V1 or [https://www.wikidoc.org/index.php/S_wave S]V2 + [https://www.wikidoc.org/index.php/R_wave R]V5 or [https://www.wikidoc.org/index.php/R_wave R]V6 ≥3.5 mV
+**Total [https://www.wikidoc.org/index.php/QRS_complex QRS] amplitude in each of the limb leads ≤0.8 mV
+**[https://www.wikidoc.org/index.php/R_wave R]/[https://www.wikidoc.org/index.php/S_wave S] ratio <1 in lead V4
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Cardiomegaly Cardiomegaly]
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
+*Previous [https://www.wikidoc.org/index.php/Myocardial_infarction myocardial infarction]
+*[https://www.wikidoc.org/index.php/Hypertension Hypertension] ([https://www.wikidoc.org/index.php/Systemic_hypertension systemic] and [https://www.wikidoc.org/index.php/Pulmonary_hypertension pulmonary])
+*[https://www.wikidoc.org/index.php/Cardiac_arrhythmia Cardiac arrythmias]
+*[https://www.wikidoc.org/index.php/Viral Viral] infections ([https://www.wikidoc.org/index.php/Myocarditis myocarditis])
+*[https://www.wikidoc.org/index.php/Congenital_heart_disease Congenital heart defects]
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Right_heart_failure Right heart failure] associated with:
+**[https://www.wikidoc.org/index.php/Hepatomegaly Hepatomegaly]
+**Positive hepato-jugular reflex
+**Increased [https://www.wikidoc.org/index.php/Jugular_venous_pressure jugular venous pressure]
+**[https://www.wikidoc.org/index.php/Peripheral_edema Peripheral edema]
+*[https://www.wikidoc.org/index.php/Left_heart_failure Left heart failure] associated with:
+**[https://www.wikidoc.org/index.php/Pulmonary_edema Pulmonary edema]
+**Eventual [https://www.wikidoc.org/index.php/Right_heart_failure right heart failure]
 |-
-|-bgcolor="LightSteelBlue"
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Percarditis Percarditis]
-| '''Drug Side Effect'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"| [[Dantrolene]], [[doxorubicin]], [[hydralazine]], [[isoniazid]], [[penicillin]], [[phenylbutazone]], [[procainamide]]
+*On contrast enhanced [https://www.wikidoc.org/index.php/Computed_tomography CT scan]:
+**Enhancement of the [https://www.wikidoc.org/index.php/Pericardium pericardium] (due to [https://www.wikidoc.org/index.php/Inflammation inflammation])
+**[https://www.wikidoc.org/index.php/Pericardial_effusion Pericardial effusion]
+**[https://www.wikidoc.org/index.php/Pericardial_calcification Pericardial calcification]
+*On [https://www.wikidoc.org/index.php/Gadolinium gadolinium]-enhanced fat-saturated [https://www.wikidoc.org/index.php/Magnetic_resonance_imaging T1-weighted MRI]:
+**[https://www.wikidoc.org/index.php/Pericardial Pericardial] enhancement (due to [https://www.wikidoc.org/index.php/Inflammation inflammation])
+**[https://www.wikidoc.org/index.php/Pericardial_effusion Pericardial effusion]
+| style="background: #F5F5F5; padding: 5px;" |
+*ST elevation
+*PR depression
+| style="background: #F5F5F5; padding: 5px;" |
+*Large collection of fluid inside the pericardial sac (pericardial effusion)
+*Calcification of pericardial sac
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔ (Low grade)
+| style="background: #F5F5F5; padding: 5px;" |✔ (Relieved by sitting up and leaning forward)
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
+*Infections:
+**[https://www.wikidoc.org/index.php/Viral Viral] (Coxsackie virus, [https://www.wikidoc.org/index.php/Herpes_simplex_virus Herpes virus], [https://www.wikidoc.org/index.php/Mumps_virus Mumps virus], [https://www.wikidoc.org/index.php/Human_Immunodeficiency_Virus_(HIV) HIV])
+**[https://www.wikidoc.org/index.php/Bacteria Bacteria] ([https://www.wikidoc.org/index.php/Mycobacterium_tuberculosis Mycobacterium tuberculosis]-common in developing countries)
+**[https://www.wikidoc.org/index.php/Fungal Fungal] ([https://www.wikidoc.org/index.php/Histoplasmosis Histoplasmosis])
+*Idiopathic in a large number of cases
+*[https://www.wikidoc.org/index.php/Autoimmune Autoimmune]
+*[https://www.wikidoc.org/index.php/Uremia Uremia]
+*[https://www.wikidoc.org/index.php/Malignancy Malignancy]
+*Previous [https://www.wikidoc.org/index.php/Myocardial_infarction myocardial infarction]
+| style="background: #F5F5F5; padding: 5px;" |
+*May be clinically classified into:
+**Acute (< 6 weeks)
+**Sub-acute (6 weeks - 6 months)
+**Chronic (> 6 months)
 |-
-|-bgcolor="LightSteelBlue"
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Pneumonia Pneumonia]
-| '''Ear Nose Throat'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"|[[Temporal arteritis]]<ref name="pmid7210667">{{cite journal| author=Garewal HS, Uhlmann RF, Bennett RM| title=Pericardial effusion in association with giant cell arteritis. | journal=West J Med | year= 1981 | volume= 134 | issue= 1 | pages= 71-2 | pmid=7210667 | doi= | pmc=PMC1272467 | url= }} </ref>
+*On [https://www.wikidoc.org/index.php/Computed_tomography CT scan]: (not generally indicated)
-|-
+**[https://www.wikidoc.org/index.php/Consolidation_(medicine) Consolidation] ([https://www.wikidoc.org/index.php/Alveolar alveolar]/lobar pneumonia)
-|-bgcolor="LightSteelBlue"
+**Peribronchial [https://www.wikidoc.org/index.php/Nodules nodules] ([https://www.wikidoc.org/index.php/Bronchopneumonia bronchopneumonia])
-| '''Endocrine'''
+**[https://www.wikidoc.org/index.php/Ground_glass_opacification_on_CT Ground-glass opacity] (GGO)
-|bgcolor="Beige"| [[Addisonian crisis]], [[hypothyroidism|Severe hypothyroidism (myxedema)]]
+**[https://www.wikidoc.org/index.php/Abscess Abscess]
-|-
+**[https://www.wikidoc.org/index.php/Pleural_effusion Pleural effusion]
-|-bgcolor="LightSteelBlue"
+**On [https://www.wikidoc.org/index.php/MRI MRI]:
-| '''Environmental'''
+*Not indicated
-|bgcolor="Beige"| No underlying causes
+| style="background: #F5F5F5; padding: 5px;" |
+*Prolonged [https://www.wikidoc.org/index.php/PR_interval PR interval]
+*Transient [https://www.wikidoc.org/index.php/T_wave T wave] inversions
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Consolidation_(medicine) Consolidation] ([https://www.wikidoc.org/index.php/Alveolar alveolar]/lobar [https://www.wikidoc.org/index.php/Pneumonia pneumonia])
+*Peribronchial [https://www.wikidoc.org/index.php/Nodules nodules] (bronchopneumonia)
+*Ground-glass opacity (GGO)
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
+*Ill-contact
+*Travelling
+*[https://www.wikidoc.org/index.php/Smoking Smoking]
+*[https://www.wikidoc.org/index.php/Diabetes_mellitus Diabetic]
+*Recent hospitalization
+*[https://www.wikidoc.org/index.php/Chronic_obstructive_pulmonary_disease Chronic obstructive pulmonary disease]
+| style="background: #F5F5F5; padding: 5px;" |
+*Requires [https://www.wikidoc.org/index.php/Sputum sputum stain] and culture for diagnosis
+*[https://www.wikidoc.org/index.php/Empiric_therapy Empiric management] usually started before [https://www.wikidoc.org/index.php/Culture_collection culture] results
 |-
-|-bgcolor="LightSteelBlue"
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Vasculitis Vasculitis]
-| '''Gastroenterologic'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"|[[Inflammatory bowel disease]], [[Whipple's]]
+*On [https://www.wikidoc.org/index.php/Computed_tomography CT scan]: ([https://www.wikidoc.org/index.php/Takayasu's_arteritis Takayasu arteritis])
-|-
+**[https://www.wikidoc.org/index.php/Blood_vessel Vessel] wall thickening
-|-bgcolor="LightSteelBlue"
+**Luminal narrowing of [https://www.wikidoc.org/index.php/Pulmonary_artery pulmonary artery]
-| '''Genetic'''
+**Masses or nodules ([https://www.wikidoc.org/index.php/Anti-neutrophil_cytoplasmic_antibody ANCA]-associated granulomatous vasculitis)
-|bgcolor="Beige"| [[Gaucher disease]], [[Jacobsen syndrome|Jacobs arthropathy-camptodactyly syndrome]], [[Mulibrey nanism|Mulibrey nanism syndrome]], [[recurrent hereditary polyserositis]]
+*On [https://www.wikidoc.org/index.php/Magnetic_resonance_imaging MRI]:
-|-
-|-bgcolor="LightSteelBlue"
+Homogeneous, circumferential [https://www.wikidoc.org/index.php/Blood_vessel vessel] wall [https://www.wikidoc.org/index.php/Swelling swelling]
-| '''Hematologic'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"| [[Leukemia]], [[lymphoma]]
+*[https://www.wikidoc.org/index.php/Bundle_branch_block Right or left bundle-branch block] ([https://www.wikidoc.org/index.php/Churg-Strauss_syndrome Churg-Strauss syndrome])
-|-
+*[https://www.wikidoc.org/index.php/Atrial_fibrillation Atrial fibrillation] ([https://www.wikidoc.org/index.php/Churg-Strauss_syndrome Churg-Strauss syndrome])
-|-bgcolor="LightSteelBlue"
+*Non-specific [https://www.wikidoc.org/index.php/ST_interval ST segment] and [https://www.wikidoc.org/index.php/T_wave T wave] changes
-| '''Iatrogenic'''
+| style="background: #F5F5F5; padding: 5px;" |
-|bgcolor="Beige"| [[Cardiopulmonary resuscitation]], [[postpericardiotomy syndrome]], [[radiation therapy]], [[serum sickness]], [[thoracic duct|thoracic duct obstruction secondary to tumor, surgery]]
+*[https://www.wikidoc.org/index.php/Nodule_(medicine) Nodules]
-|-
+*[https://www.wikidoc.org/index.php/Cavitation Cavitation]
-|-bgcolor="LightSteelBlue"
+| style="background: #F5F5F5; padding: 5px;" |✔
-| '''Infectious Disease'''
+| style="background: #F5F5F5; padding: 5px;" |✔
-|bgcolor="Beige"|[[Actinomycosis]], [[adenovirus]], [[hydatid cyst|alveolar hydatid disease]], [[amebiasis]], [[aspergillus]], [[blastomycosis]], [[borrelia]], [[brucellosis]], [[candida]], [[coccidiomycosis]], [[coxsackie B virus]], [[cytomegalovirus]], [[Ebstein-Barr virus]], [[echinococcus]], [[echovirus]], [[entamoeba histolytica]], [[escherichia coli]], [[francisella]], [[haemophilus influenza]], [[hepatitis B]], [[histoplasmosis]], [[influenza]], [[klebsiella]], [[legionella]], [[Lyme disease]], [[meningococci]], [[mumps]], [[mycoplasma|mycoplasma pnuemonia]], [[neisseria]], [[nocardia]], [[pneumococcus]], [[proteus]], [[pseudomonas]], [[rickettsia]], [[salmonella]], [[staphylococcus]], [[streptococcus]], [[toxoplasmosis]], [[tuberculous]], [[tularemia]], [[varicella]]
+| style="background: #F5F5F5; padding: 5px;" |✔
-|-
+| style="background: #F5F5F5; padding: 5px;" |✔
-|-bgcolor="LightSteelBlue"
+| style="background: #F5F5F5; padding: 5px;" |✔
-| '''Musculoskeletal / Ortho'''
+| style="background: #F5F5F5; padding: 5px;" |✔
-|bgcolor="Beige"| No underlying causes
+| style="background: #F5F5F5; padding: 5px;" | -
-|-
+| style="background: #F5F5F5; padding: 5px;" |✔
-|-bgcolor="LightSteelBlue"
+| style="background: #F5F5F5; padding: 5px;" |✔
-| '''Neurologic'''
+| style="background: #F5F5F5; padding: 5px;" |✔
-|bgcolor="Beige"| No underlying causes
+| style="background: #F5F5F5; padding: 5px;" |
-|-
+*[https://www.wikidoc.org/index.php/Takayasu's_arteritis Takayasu arteritis] usually found in persons aged 4-60 years with a mean of 30
-|-bgcolor="LightSteelBlue"
+*[https://www.wikidoc.org/index.php/Giant-cell_arteritis Giant-cell arteritis] usually occurrs in persons aged > 60 years
-| '''Nutritional / Metabolic'''
+*[https://www.wikidoc.org/index.php/Churg-Strauss_syndrome Churg-Strauss syndrome] may present with [https://www.wikidoc.org/index.php/Asthma asthma], [https://www.wikidoc.org/index.php/Sinusitis sinusitis], transient [https://www.wikidoc.org/index.php/Pulmonary pulmonary] infiltrates and neuropathy alongwith [https://www.wikidoc.org/index.php/Cardiac cardiac] involvement
-|bgcolor="Beige"| No underlying causes
+*Granulomatous vasculitides may present with [https://www.wikidoc.org/index.php/Nephritis nephritis] and [https://www.wikidoc.org/index.php/Upper_airway upper airway] ([https://www.wikidoc.org/index.php/Nasopharyngeal nasopharyngeal]) destruction
-|-
+| style="background: #F5F5F5; padding: 5px;" |
-|-bgcolor="LightSteelBlue"
-| '''Obstetric/Gynecologic'''
-|bgcolor="Beige"| No underlying causes
-|-
-|-bgcolor="LightSteelBlue"
-| '''Oncologic'''
-|bgcolor="Beige"|[[Breast cancer]], [[carcinoid]], [[fibroma]], [[kaposis sarcoma]], [[leukemia]], [[lipoma]], [[lung cancer]], [[lymphomas]], [[melanoma]], [[mesothelioma]], [[ovarian cancer]], [[sarcoma]], [[Sipple syndrome]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Opthalmologic'''
-|bgcolor="Beige"| No underlying causes
-|-
-|-bgcolor="LightSteelBlue"
-| '''Overdose / Toxicity'''
-|bgcolor="Beige"| No underlying causes
-|-
-|-bgcolor="LightSteelBlue"
-| '''Psychiatric'''
-|bgcolor="Beige"| No underlying causes
-|-
-|-bgcolor="LightSteelBlue"
-| '''Pulmonary'''
-|bgcolor="Beige"|[[Sarcoidosis]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Renal / Electrolyte'''
-|bgcolor="Beige"| [[Uremia]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Rheum / Immune / Allergy'''
-|bgcolor="Beige"|[[rheumatic fever|Acute rheumatic fever]], [[amyloidosis]], [[ankylosing spondylitis]], [[Behcet syndrome]], [[Kawasaki disease]], [[mixed connective tissue disease]], [[polyarteritis nodosa]], [[polymyositis]], [[Reiter's Syndrome]], [[rheumatoid arthritis]], [[sarcoidosis]], [[scleroderma]], [[Still's disease]], [[systemic lupus erythematosus]], [[systemic sclerosis]], [[temporal arteritis]], [[Wegener's]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Sexual'''
-|bgcolor="Beige"| [[Neisseria gonorrhoeae]]<ref name="pmid2317408">{{cite journal| author=Wilson J, Zaman AG, Simmons AV| title=Gonococcal arthritis complicated by acute pericarditis and pericardial effusion. | journal=Br Heart J | year= 1990 | volume= 63 | issue= 2 | pages= 134-5 | pmid=2317408 | doi= | pmc=PMC1024342 | url= }} </ref>, [[treponema pallidum]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Trauma'''
-|bgcolor="Beige"| [[chest trauma|Blunt or penetrating chest trauma]], [[esophageal rupture]], [[esophageal rupture|esophogeal perforation]], [[perforation|gastric perforation]], [[fistula|pancreatic-pericardial fistula]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Urologic'''
-|bgcolor="Beige"| [[Renal Failure]], [[uremia]]
-|-
-|-bgcolor="LightSteelBlue"
-| '''Miscellaneous'''
-|bgcolor="Beige"| [[Idiopathic]]
 |-
-|}
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[https://www.wikidoc.org/index.php/Chronic_obstructive_pulmonary_disease Chronic obstructive pulmonary disease] (COPD)
+| style="background: #F5F5F5; padding: 5px;" |
+*On [https://www.wikidoc.org/index.php/Computed_tomography CT scan]:
+**[https://www.wikidoc.org/index.php/Chronic_bronchitis Chronic bronchitis] may show [https://www.wikidoc.org/index.php/Bronchial bronchial] wall thickening, scarring with bronchovascular irregularity, [https://www.wikidoc.org/index.php/Fibrosis fibrosis]
+**[https://www.wikidoc.org/index.php/Emphysema Emphysema] may show [https://www.wikidoc.org/index.php/Alveolar alveolar] septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe)
+**Giant bubbles
+*On [https://www.wikidoc.org/index.php/MRI MRI]:
+**Increased diameter of [https://www.wikidoc.org/index.php/Pulmonary_arteries pulmonary arteries]
+**Peripheral [https://www.wikidoc.org/index.php/Pulmonary pulmonary] [https://www.wikidoc.org/index.php/Vasculature vasculature] attentuation
+**Loss of retrosternal airspace due to right ventricular enlargement
+**Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Multifocal_atrial_tachycardia Multifocal atrial tachycardia] (atleast 3 distinct [https://www.wikidoc.org/index.php/P_waves P wave] morphologies)
+| style="background: #F5F5F5; padding: 5px;" |
+*Enlarged [https://www.wikidoc.org/index.php/Lung lung] shadows ([https://www.wikidoc.org/index.php/Emphysema emphysema])
+*Flattening of [https://www.wikidoc.org/index.php/Diaphragm diaphragm] ([https://www.wikidoc.org/index.php/Emphysema emphysema])
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" |✔
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Smoking Smoking]
+*[https://www.wikidoc.org/index.php/Alpha_1-antitrypsin_deficiency Alpha-1 antitrypsin deficiency]
+*Increased [https://www.wikidoc.org/index.php/Sputum sputum] production ([https://www.wikidoc.org/index.php/Chronic_bronchitis chronic bronchitis])
+*[https://www.wikidoc.org/index.php/Cough Cough]
+| style="background: #F5F5F5; padding: 5px;" |
+*[https://www.wikidoc.org/index.php/Alpha_1-antitrypsin_deficiency Alpha 1 antitrypsin deficiency] may be associated with [https://www.wikidoc.org/index.php/Hepatomegaly hepatomegaly]
+|}<br />
 ==References==

Pericardial effusion differential diagnosis: Difference between revisions

Revision as of 08:06, 2 March 2020

Overview

Differentiating Pericardial Effusion from other Diseases

References

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