Pericardial effusion
Definition
An inflammation of the pericardium; the visceral pericardium may react by secreting fluid.
Etiology
- Idiopathic
- Infectious (e. g., viral, bacterial)
- Neoplastic
- Radiation injury
- Uremia
- Rheumatoid diseases
- Acute myocardial infarction
- Trauma
- Drug induced
- Tuberculosis
- Post-cardiac surgery
- Dressler's syndrome
- Collagen vascular disease (lupus erythematosus)
- Aortic dissection
Signs and Symptoms
- Chest pain
- Dyspnea
Complications
- Cardiac tamponade
- Chronic pericarditis may lead to constrictive pericarditis
Cardiac Auscultation
- Pericardial friction rub may or may not be present
Electrocardiogram
- Reduction in QRS voltage
- Elevated ST segments throughout electrocardiogram
- Electrical alternans
Chest X-ray
- Cardiomegaly
Pericardial Effusion Severity Scale
- Physiologic : A separation seen in systole only
- Small : Clear space in systole and diastole < 1 cm
- Moderate : Posterior clear space maintained in systole and diastole and ≥1 cm
- Large :
Clear space ≥2 cm or an anterior and posterior clear space seen in systole and diastole
Differential Diagnosis
- Epicardial fat is sandwiched in between the epicardium and myocardium and is primarily located anteriorly
- Epicardial fat appears on the echocardiogram as an anterior clear space and may be confused with pericardial effusion. It is unusual for effusions to be located anteriorly unless loculated.
- If the diagnosis is not apparent, then the following should be reported: "Anterior clear space noted, probably adipose tissue but cannot rule out pericardial cyst, tumor, extracardiac mass, thymus gland or loculated effusion. Clinical correlation is suggested.
- Pleural effusion may present as a posterior clear space.
- A pericardial effusion is anterior to the descending thoracic aorta while a pleural effusion is posterior to the descending aorta.
- A pericardial effusion gradually tapers at the atrioventricular groove, while a pleural effusion is normally behind the left ventricle and left atrium.
- A pericardial effusion does not change with respiration, while a pleural effusion may change with respiration.
M-Mode
- Echo-free space between the epicardium and the pericardium
- Pericardial motion becomes attenuated
2-D
- Echo-free space between the epicardium and the pericardium
Important to Note
When a large effusion is present, the following diagnoses should be deferred until the effusion abates: mitral valve prolapse, tricuspid valve prolapse, aortic valve prolapse, pulmonic valve prolapse, systolic anterior motion of the mitral valve, mid-systolic notching of the pulmonary valve, and mid-systolic notching of the aortic valve.