What does the absence of pericardial effusion indicate?

From the Guidelines

Pericardial effusion absent means there is no abnormal accumulation of fluid in the pericardial space, indicating a normal finding on imaging studies. This is a reassuring result, as it suggests that there is no inflammation or other pathological process affecting the pericardium at the time of imaging, such as infections, autoimmune disorders, cancer, kidney failure, or heart surgery 1. The absence of pericardial effusion is the expected healthy state of the pericardial space. When a pericardial effusion is present, it is often associated with a known disease, and treatment should be targeted at the underlying disease, as stated in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. However, in the case of pericardial effusion absent, no specific treatment is needed, as it represents a normal finding. Some key points to consider in the context of pericardial effusion include:

• The essential treatment is that of the underlying disease, when the effusion is associated with a known disease 1
• Pericardiocentesis with prolonged pericardial drainage may be considered in certain cases, but evidence to support this indication is based on case reports, retrospective studies, and expert opinion 1
• In the absence of inflammation, NSAIDs, colchicine, and corticosteroids are generally not effective in reducing an isolated effusion 1 Overall, the absence of pericardial effusion is a positive finding, indicating no abnormal fluid accumulation in the pericardial space, and no specific treatment is needed for this normal finding.

From the Research

Definition of Pericardial Effusion Absent

• Pericardial effusion absent refers to the lack of excess fluid in the pericardial cavity, which is the space between the heart and the pericardium (the sac that surrounds the heart) 2.
• The normal volume of pericardial fluid is approximately 10-50 ml, and an effusion occurs when this volume is exceeded 2.
• The absence of pericardial effusion means that the pericardial fluid volume is within the normal range, and there is no abnormal accumulation of fluid in the pericardial cavity.

Clinical Implications

• The absence of pericardial effusion is generally a good sign, as it indicates that the heart and pericardium are functioning normally 3, 4.
• However, it is essential to note that the absence of pericardial effusion does not rule out other cardiac conditions, such as pericarditis or cardiac tamponade 5, 6.
• A thorough clinical evaluation, including imaging studies and physical examination, is necessary to determine the underlying cause of any cardiac symptoms and to rule out other potential conditions 3, 4, 6.

Diagnostic Considerations

• Echocardiography is a commonly used imaging modality to evaluate the pericardial cavity and detect pericardial effusion 3, 4, 6.
• Other imaging studies, such as chest X-ray, electrocardiogram, computed tomography scan, and cardiac magnetic resonance imaging, may also be used to evaluate the pericardial cavity and detect pericardial effusion 2.
• A semi-quantification of the pericardial effusion may be obtained by measuring the distance between the two pericardial layers using focused cardiac ultrasound (FOCUS) 6.