From the Guidelines
Pericardial effusion severity can range from mild to life-threatening, depending on the underlying cause and size of the effusion.
Classification and Severity
- Pericardial effusion can be classified according to its onset, distribution, hemodynamic impact, composition, and size, with size being a key factor in determining severity 1.
- The size of the effusion is correlated with the prognosis, as moderate to large effusions are more common for specific aetiologies such as bacterial and neoplastic conditions 1.
- Large idiopathic chronic effusions (>3 months) have a 30–35% risk of progression to cardiac tamponade, a life-threatening condition 1.
Causes and Risk Factors
- The prognosis of pericardial effusion is essentially related to the aetiology, with idiopathic pericardial effusion and pericarditis having an overall good prognosis, while neoplastic and bacterial conditions have a poorer prognosis 1.
- Cancer, infections, iatrogenic causes, and connective tissue diseases are common causes of pericardial effusion, with the prevalence of malignant or infectious aetiologies ranging from 15 to 50% depending on the published series 1.
Diagnosis and Treatment
- Echocardiography is the single most useful diagnostic tool to identify pericardial effusion and estimate its size, location, and degree of hemodynamic impact 1.
- Treatment of cardiac tamponade involves drainage of the pericardial fluid, preferably by needle pericardiocentesis, with the use of echocardiographic or fluoroscopic guidance, and should be performed without delay in unstable patients 1.
- Pericardiocentesis should be carried out for cardiac tamponade, large pericardial effusions (≥ 2cm), or for diagnostic purposes, with factors such as age, platelet counts, and presence of malignant cells in the effusion influencing prognosis 1.
From the Research
Severity of Pericardial Effusion
The severity of pericardial effusion can vary widely, ranging from asymptomatic, incidentally discovered small effusions to life-threatening cardiac tamponade 2, 3. The management of patients with pericardial effusions is mainly based on four parameters:
- Haemodynamic impact on diastolic function
- Elevation of inflammatory markers
- Presence of a specific underlying condition known to be associated with pericardial effusion
- Size and duration of the effusion 2.
Clinical Manifestations
Pericardial effusions can have a variety of clinical manifestations, including:
- Asymptomatic cases
- Incidentally discovered small effusions
- Life-threatening cardiac tamponade 2, 3
- Haemodynamic compromise 4 The size of the effusion, the presence of tamponade, and inflammatory signs can be useful in determining the causes of moderate or severe pericardial effusions 5.
Factors Influencing Severity
Several factors can influence the severity of pericardial effusion, including:
- Size of the effusion
- Presence of inflammatory markers
- Underlying medical conditions
- Aetiology of the effusion 2, 5, 3, 6
- Comorbidities
- Location of the pericardial effusion 3
Prognosis
The prognosis of pericardial effusions largely depends on the underlying etiologies, with metastatic spread to the pericardium having an ominous prognosis, while large to moderate effusions are often associated with known or newly discovered specific underlying causes 3. Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring, whereas large chronic idiopathic effusions in clinically stable patients require a 3 to 6-month assessment ideally in a specialized unit 3.