What are the causes of pericardial effusion?

From the Guidelines

Pericardial effusion is primarily caused by malignancies, infections, autoimmune disorders, and iatrogenic factors, with the most common malignancies being lung cancer, breast cancer, lymphoma, and leukemia, as reported in the most recent study 1. The causes of pericardial effusion can be categorized into several groups, including:

• Malignancies: lung cancer, breast cancer, lymphoma, and leukemia, which can invade the pericardial space through direct tumor extension or metastatic spread via lymphatics or blood 1
• Infections: viral, bacterial, fungal, or tuberculous, which can cause inflammation of the pericardium leading to increased production of pericardial fluid 1
• Autoimmune disorders: lupus, rheumatoid arthritis, and scleroderma, which can cause inflammation of the pericardium leading to pericardial effusion 1
• Iatrogenic factors: post-cardiac surgery or radiation therapy, which can cause pericardial disease, including effusion and/or constriction, in 6-30% of patients 1 Other significant causes of pericardial effusion include:
• Myocardial infarction
• Uremia in kidney failure
• Hypothyroidism
• Trauma to the chest
• Certain medications like hydralazine, procainamide, and phenytoin It is essential to note that idiopathic pericardial effusion, where no specific cause can be identified, accounts for many cases, and the underlying mechanism involves inflammation of the pericardium leading to increased production of pericardial fluid, decreased reabsorption, or both 1. The severity of pericardial effusion depends on the amount of fluid accumulated and how quickly it develops, with rapid accumulation potentially leading to cardiac tamponade, a life-threatening condition requiring immediate intervention 1. The diagnosis and management of pericardial effusion should be guided by the most recent and highest quality evidence, which recommends echocardiography as the imaging modality of choice and emergency pericardiocentesis for cardiac tamponade or large pericardial effusions 1.

From the Research

Causes of Pericardial Effusion

The causes of pericardial effusion can be numerous and are generally divided into inflammatory and non-inflammatory etiologies 2. Some of the common causes include:

• Idiopathic pericarditis
• Cancer
• Connective tissue disorders
• Hemorrhage 3
• Autoimmune and autoinflammatory conditions, such as systemic rheumatologic diseases 4
• Metabolic disease
• Neoplastic disease
• Specific conditions known to be associated with pericardial effusion, such as tuberculosis 4, 5

Inflammatory Etiologies

Inflammatory causes of pericardial effusion can include:

• Acute pericarditis
• Recurrent pericarditis
• Constrictive pericarditis
• Pericardial tamponade 6, 4

Non-Inflammatory Etiologies

Non-inflammatory causes of pericardial effusion can include:

• Dehydration
• Exposure to certain medications, such as vasodilators or intravenous diuretics 6
• Chest trauma
• Complications of interventional and surgical procedures 6
• Aortic dissection
• Bleeding or purulent infection 6