From the Guidelines
Pericardial effusion can be severe and life-threatening, particularly when it leads to cardiac tamponade. The severity of pericardial effusion is determined by its size, distribution, and hemodynamic impact.
Classification of Pericardial Effusion
- Size: Pericardial effusion can be classified as mild (<10 mm), moderate (10-20 mm), or large (>20 mm) based on a simple semiquantitative echocardiographic assessment 1.
- Distribution: Pericardial effusion can be circumferential or loculated.
- Hemodynamic impact: Pericardial effusion can have no hemodynamic impact, or it can lead to cardiac tamponade or effusive-constrictive pericarditis.
Causes of Pericardial Effusion
- Malignant pericardial effusion: Can be caused by primary tumors of the pericardium, such as mesothelioma, or by secondary tumors, such as lung cancer, breast cancer, or lymphoma 1.
- Non-malignant pericardial effusion: Can be caused by radiation pericarditis, other therapies, or opportunistic infections 1.
Diagnosis of Pericardial Effusion
- Echocardiography: Is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of hemodynamic impact 1.
- Pericardiocentesis: Can be used to relieve symptoms, establish a diagnosis, and prevent recurrences of pericardial effusion 1.
Treatment of Pericardial Effusion
- Pericardiocentesis: Is a class I indication for cardiac tamponade and can be used to relieve symptoms and establish a diagnosis 1.
- Intrapericardial instillation of cytostatic/sclerosing agents: Can be used to prevent recurrences of pericardial effusion 1.
- Surgical pericardiotomy: Can be used in cases where pericardiocentesis cannot be performed or is ineffective 1.
Some key points to note are that pericardial effusion can be asymptomatic, but it can also lead to cardiac tamponade, which is a life-threatening condition that requires immediate treatment. The diagnosis of pericardial effusion is typically made using echocardiography, and the treatment depends on the underlying cause and the severity of the effusion. In cases of malignant pericardial effusion, the treatment may involve systemic antineoplastic therapy, pericardiocentesis, and intrapericardial instillation of cytostatic/sclerosing agents 1.
From the Research
Severity of Pericardial Effusion
The severity of pericardial effusion can range from asymptomatic to life-threatening cardiac tamponade 2, 3, 4, 5, 6.
- Asymptomatic cases may be incidentally discovered, while severe cases can lead to cardiac tamponade, a critical condition that restricts cardiac filling and can cause hypotension and cardiac arrest 3.
- The size of the effusion, presence of tamponade, and inflammatory signs can be useful in determining the causes of moderate or severe pericardial effusions 5.
- Large effusions can be associated with an increased risk of progression to cardiac tamponade, and pericardiocentesis may be necessary for therapeutic and diagnostic purposes 4, 6.
Clinical Manifestations
Pericardial effusion can have a variety of clinical manifestations, including:
- Asymptomatic cases
- Incidentally discovered small effusions
- Large effusions with or without symptoms
- Cardiac tamponade, a life-threatening condition
- Hemodynamic compromise requiring pericardial drainage 2, 3, 4, 5, 6.
Management and Prognosis
The management of pericardial effusion depends on the underlying etiology, size, and location of the effusion, as well as the presence of symptoms or hemodynamic compromise 4, 6.
- Asymptomatic or minimally symptomatic chronic large idiopathic pericardial effusions may be managed with a conservative approach and watchful waiting 6.
- The prognosis of pericardial effusions largely depends on the underlying etiologies, with metastatic spread to the pericardium having an ominous prognosis 6.