Pericardial effusion overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]
Overview
There is limited information about the historical perspective of pericardial effusion. However, percutaneous pericardiocentesis was first described in 1840 by Frank Schuh. By the 20th century, pericardiocentesis became the established technique for diagnosing and treating pericardial effusion. Before echocardiography, surgeons used a blind-subxiphoid approach; however, this was associated with serious organ injuries. However, the introduction of echo-guided pericardiocentesis improved the accuracy and safety of the procedure. The technique has been further refined over the past four decades.Pericardial effusion can be classified according to the nature of pericardial fluid into transudative, exudative, hemorrhagic, and malignant. Further, it can be classified according to the underlying cause into idiopathic, infectious, neoplastic, and post-operative. In addition, Horowitz et al. developed a classification for pericardial effusions based on echocardiographic findings (the degree of separation between the pericardium and epicardium). Pericardial effusion can be classified into serous, bloody and chylous effusions based on the composition of the effusion fluid. Infections and inflammation usually cause serous effusion while bloody effusions are as a result of trauma to the heart. Though iatrogenic causes and infections are the common etiologies, pericardial disease may also be a feature of other disorders such as inflammatory bowel disease. Aortic dissection or free wall rupture should also be considered in patients with unstable hemodynamics and pericardial tamponade.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.The underlying cause of pericardial effusion depend on the region where the patient is living. While malignancy is the most common cause of pericardial effusion in developed countries, infections such as tuberculosis and HIV seems to be the main etiologies of pericardial effusion in developing countries.
Historical Perspective
There is limited information about the historical perspective of pericardial effusion. However, percutaneous pericardiocentesis was first described in 1840 by Frank Schuh. By the 20th century, pericardiocentesis became the established technique for diagnosing and treating pericardial effusion. Before echocardiography, surgeons used a blind-subxiphoid approach; however, this was associated with serious organ injuries. However, the introduction of echo-guided pericardiocentesis improved the accuracy and safety of the procedure. The technique has been further refined over the past four decades.
Classification
Pericardial effusion can be classified according to the nature of pericardial fluid into transudative, exudative, hemorrhagic, and malignant. Further, it can be classified according to the underlying cause into idiopathic, infectious, neoplastic, and post-operative. In addition, Horowitz et al. developed a classification for pericardial effusions based on echocardiographic findings (the degree of separation between the pericardium and epicardium).
Pathophysiology
Causes
Pericardial effusion can be classified into serous, bloody and chylous effusions based on the composition of the effusion fluid. Infections and inflammation usually cause serous effusion while bloody effusions are as a result of trauma to the heart. Though iatrogenic causes and infections are the common etiologies, pericardial disease may also be a feature of other disorders such as inflammatory bowel disease. Aortic dissection or free wall rupture should also be considered in patients with unstable hemodynamics and pericardial tamponade.
Differentiating Pericardial Effusion from Other Diseases
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.
Epidemiology and Demographics
The underlying cause of pericardial effusion depend on the region where the patient is living. While malignancy is the most common cause of pericardial effusion in developed countries, infections such as tuberculosis and HIV seems to be the main etiologies of pericardial effusion in developing countries.
Risk Factors
Screening
There is insufficient evidence to recommend routine screening for pericardial effusion.