What causes pericardial effusion?

From the Guidelines

Pericardial effusion is caused by a variety of factors, including infections, autoimmune disorders, cancer, kidney failure, hypothyroidism, trauma, heart surgery complications, certain medications, and radiation therapy, with the most common causes being infections and cancer, as reported in the 2015 ESC guidelines 1. The causes of pericardial effusion can be categorized into several groups, including:

• Infections, such as viral, bacterial, fungal, or tuberculous pericarditis, with viral pericarditis being the most common infection, as stated in the 2004 European Society of Cardiology guidelines 1
• Autoimmune disorders, such as lupus or rheumatoid arthritis, which can cause pericardial effusion due to inflammation and immune system dysfunction
• Cancer, including primary tumors or metastases, with lung cancer, breast cancer, and lymphomas being the most common types of cancer associated with pericardial effusion, as reported in the 2015 ESC guidelines 1
• Kidney failure with uremia, which can cause pericardial effusion due to the buildup of toxins in the blood
• Hypothyroidism, which can cause pericardial effusion due to the accumulation of fluid in the pericardial space
• Trauma to the chest, which can cause pericardial effusion due to bleeding or fluid accumulation in the pericardial space
• Heart surgery complications, which can cause pericardial effusion due to inflammation or bleeding
• Certain medications, such as chemotherapy drugs like doxorubicin, which can cause pericardial effusion as a side effect
• Radiation therapy to the chest, which can cause pericardial effusion due to inflammation and damage to the pericardium. In some cases, idiopathic pericardial effusion occurs without an identifiable cause, as stated in the 2015 ESC guidelines 1. The fluid builds up when inflammation affects the pericardium, causing increased production of pericardial fluid or decreased reabsorption, and the severity depends on how quickly the fluid accumulates, with rapid accumulation being more dangerous as it can lead to cardiac tamponade, where pressure on the heart prevents proper filling and can be life-threatening, as reported in the 2015 ESC guidelines 1. Treatment targets the underlying cause while monitoring for complications, and may include anti-inflammatory medications, antibiotics for infections, or drainage procedures in severe cases, as stated in the 2015 ESC guidelines 1.

From the Research

Causes of Pericardial Effusion

• Pericardial effusion can be caused by various conditions, including autoimmune diseases, malignancies, metabolic disorders, and idiopathic cases 2, 3, 4, 5.
• The etiology of pericardial effusion can be divided into inflammatory and non-inflammatory causes 3.
• Specific conditions that can cause pericardial effusion include:
  • Acute myocardial infarction
  • Cardiac surgery
  • End-stage renal disease
  • Widespread metastatic neoplasm
  • Tuberculous pericarditis (common in underdeveloped geographic areas) 4
  • Autoimmune diseases
  • Neoplastic diseases
  • Metabolic disorders

Diagnosis and Evaluation

• Echocardiography is essential for defining the location and size of the pericardial effusion 3, 5.
• The diagnosis of pericardial effusion can be established through various imaging techniques, including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis 6.
• The evaluation of pericardial effusion should take into account the presence of hemodynamic compromise, suspicion of malignant or purulent pericarditis, and the size and duration of the effusion 5.

Prognosis

• The prognosis of pericardial effusions largely depends on the underlying etiologies 2, 5.
• Metastatic spread to the pericardium has an ominous prognosis, while large to moderate effusions have been often associated with known or newly discovered specific underlying causes 2.
• Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring 2.
• The prognosis of individuals with idiopathic, chronic, large, asymptomatic pericardial effusions is usually benign 5.