Pericarditis pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

Pericarditis can be classified according to the composition of the inflammatory exudate or the composition of the fluid that accumulates around the heart.

Types include:

Acute Versus Chronic Pericarditis

Depending on the timing of presentation and duration, pericarditis is divided into "acute" and "chronic" forms. Clinically, acute pericarditis presents within 6 weeks of the disease onset; subacute pericarditis presents within 6 weeks to 6 months of the disease onset; and chronic pericarditis manifests after 6 months of the disease onset.Acute pericarditis is more common than chronic pericarditis, and often occurs as a complication of viral infections, immunologic conditions, or as a result of a heart attack (myocardial infarction). Chronic pericarditis is less common, which may manifest as scarring of the pericardium a condition known as constrictive pericarditis.

Gross Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Fibrinous pericarditis: Gross, natural color, an excellent example of bread and butter appearance. Uremia, chronic glomerulonephritis and sepsis.
Fibrinous pericarditis: Gross, a good example (bread and butter appearance).
Fibrinous pericarditis: Gross, an excellent example.

Fibrinous pericarditis: Gross, an excellent example, close-up view of fibrin.
Fibrinous pericarditis: Gross, an excellent example, close-up view.
Fibrinous pericarditis: Gross, an excellent example.

Fibrinous pericarditis: Gross, external view of localized pericarditis over an acute infarction
Fibrinous pericarditis: Gross, intact heart, good example
Fibrinous pericarditis: Gross, good example, mild, with small amount of fibrin

Fibrinous pericarditis: Gross, close-up, an excellent example of color and detail
Fibrinous pericarditis: Gross, a good example
Fibrinous pericarditis: Gross, a good example, very mild case

Fibrinous pericarditis: Gross, an excellent example.
Fibrinous pericarditis: Gross, a close-up view, an excellent illustration of fibrinous exudate.
Pericarditis in uremia

Fibrinous pericarditis: Gross, fixed tissue (note to color changes), a close-up view of fibrin on epicardial surface of heart. A typical example.
Fibrinous pericarditis: Gross, natural color, large right atrial thrombus and fibrinous pericarditis. Normal tricuspid valve with some aging changes (good example)
Fibrinous pericarditis: Gross, natural color

Fibrinous pericarditis: Gross, natural color, an excellent example
Fibrinous pericarditis: Gross, natural color, very close-up photo showing fibrinous exudate simulating frost (an excellent example)
Rheumatoid fibrinous pericarditis: Gross, natural color, a typical lesion in 22 years old white female due to juvenile rheumatoid arthritis.

Fibrinous pericarditis: Gross, natural color, close-up view of minimal fibrinous exudate on epicardial surface due to terminal renal failure
Fibrinous pericarditis: Gross, natural color, anterior view of heart with mild fibrinous exudate over epicardium due to terminal renal failure
Tuberculous pericarditis: Gross, natural color, shaggy hemorrhagic exudate. This case is much more hemorrhagic than the typical tuberculous pericarditis.

Heart transplant: Gross, natural color, external view of heart. Two months after transplantation with fibrinous pericarditis
Neoplastic pericarditis: Gross, natural color, shaggy pericarditis. Primer is adenocarcinoma of the lung.
Heart: Septic pericarditis

Hemopericardium: Gross, an excellent in situ view
Hemopericardium: Gross, in situ, unopened pericardium (a very good example)
Hemopericardium: Gross, natural color, heart in situ with opened pericardium and filled with red blood clot (quite good example) dissecting aneurysm

Hemopericardium due to Needle Puncture: Gross, natural color, external view of heart covered by blood
Needle Puncture Mark in Epicardium: Gross, natural color, close-up of needle puncture marks tap resulted in hemopericardium
Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, close-up view of apex of the heart. Needle apparently entered the distal posterior descending artery.

Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, view of apex of the heart. Needle apparently entered the distal posterior descending artery
Hemopericardium: Hemopericardium due to pericardiocentesis: Gross, fixed tissue, close-up view of slice through distal posterior descending artery showing periarterial hemorrhage
Hemopericardium: Liver: Gross, natural color, typical shock liver case of death due to hemopericardium secondary to pericardiocentesis

Hemopericardium in newborn: Gross, natural color, opened body with large collection blood in pericardial sac. Cause uncertain. A 26 week premature with hyaline membrane disease and DIC
Hemopericardium: Myocardial Infarction and Ventricular Rupture

Hemopericardium: Infarct rupture after 7 days of chest pain onset.
Hemopericardium in dissecting aneurysm: Gross, heart with root of aorta to show hemorrhage into pericardium (very good example)

Microscopic Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Tuberculous pericarditis.
Tuberculous pericarditis.
Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.

Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.
Uremic pericarditis: Micro med mag, H&E. A good example
Tuberculous pericarditis: Micro med mag, H&E, a typical lesion

Fibrinous pericarditis.
Pericarditis fibrinosa (Fibrinous pericarditis).
Malignant Mesothelioma, Biphasic Type: Pericardium: This tumor has epithelioid cells (lower half) surrounded by spindled cells. The patient was a 46-year-old woman with constrictive pericarditis; the pericardium was studded with coalescing tumor nodules.