What causes a pericardial effusion?

From the Guidelines

Pericardial effusion can be caused by various conditions, including cancer, chemotherapy, radiation therapy, infections, and certain medications, as well as autoimmune disorders, heart attacks, and trauma to the chest or heart. The causes of pericardial effusion can be broadly categorized into several groups, including:

• Infections, such as viral, bacterial, fungal, or tuberculous pericarditis 1
• Autoimmune disorders, such as lupus, rheumatoid arthritis, or scleroderma
• Cancer, including primary tumors or metastases, with lung cancer, breast cancer, leukemia, and lymphoma being common causes 1
• Chemotherapy, with anthracyclines, cyclophosphamide, and cytarabine being associated with pericardial diseases 1
• Radiation therapy, which can cause pericardial disease in 6-30% of patients 1
• Certain medications, including hydralazine, procainamide, phenytoin, isoniazid, and some chemotherapy drugs
• Heart attacks, heart surgery, kidney failure with uremia, hypothyroidism, and trauma to the chest or heart The fluid accumulates in the pericardial space due to inflammation of the pericardium, disruption in fluid drainage, or increased fluid production within the pericardial space 1. The severity of symptoms depends on how quickly the fluid accumulates and how much pressure it places on the heart, potentially leading to cardiac tamponade in severe cases where urgent drainage may be required. According to the 2015 ESC guidelines, therapy of pericardial effusion should be targeted at the aetiology as much as possible, and pericardiocentesis with prolonged pericardial drainage may be considered to promote adherence of pericardial layers and prevent further accumulation of fluid 1.

From the Research

Causes of Pericardial Effusion

• Pericardial effusion can be caused by various factors, including acute myocardial infarction, cardiac surgery, end-stage renal disease, and widespread metastatic neoplasm 2
• Idiopathic pericarditis and idiopathic pericardial effusion are the most common etiologies in developed countries, while tuberculous pericarditis is a leading cause in some underdeveloped geographic areas 2
• Rheumatoid arthritis (RA) can also cause pericardial effusion, even in the absence of articular symptoms 3
• Other causes of pericardial effusion include pericarditis in systemic rheumatologic diseases, such as autoimmune and autoinflammatory conditions 4
• Inflammatory and non-inflammatory etiologies can also cause pericardial effusions, including bacterial infections and malignancy 5

Specific Causes

• Acute idiopathic pericarditis can cause pericardial effusion, characterized by acute inflammatory signs such as chest pain, fever, and pericardial friction rub 2
• Neoplastic pericardial effusion can occur in patients with underlying neoplasia, and is often associated with tamponade without inflammatory signs 2
• Chronic idiopathic pericardial effusion can cause severe effusion with absence of inflammatory signs and absence of tamponade 2
• Pericardial effusion can also be caused by other conditions, such as pneumonia, and can be a presenting manifestation of an underlying disease 3

Diagnosis and Treatment

• Echocardiography is essential for diagnosing pericardial effusion and defining the location and size of the effusion 2, 5
• Pericardiocentesis is performed in patients with tamponade, and can be used to diagnose and treat pericardial effusion 2, 5
• Treatment options for pericardial effusion include pericardiocentesis, pericardial window, and sclerosing therapies, as well as medical treatment with immunosuppressive medications and biologics 2, 4, 5, 6