From the Guidelines
The 2015 ESC guidelines for diagnosis and management of pericardial effusion recommend a stepwise approach based on size, hemodynamic impact, and etiology. Diagnosis should begin with echocardiography to assess effusion size and signs of tamponade 1. The guidelines categorize effusions as small (<10mm), moderate (10-20mm), and large (>20mm) 1.
- Asymptomatic small effusions without tamponade can be monitored without specific intervention, with a good prognosis and no requirement for specific monitoring 1.
- For idiopathic moderate effusions, an appropriate timing for echocardiographic follow-up may be an echocardiogram every 6 months 1.
- For a severe effusion, an echocardiographic follow-up may be every 3–6 months 1. Additional diagnostic tools include chest X-ray, CT, MRI, and pericardiocentesis with fluid analysis when indicated 1. Management depends on hemodynamic impact and underlying cause.
- For symptomatic effusions, pericardiocentesis is indicated, preferably with echocardiographic guidance 1.
- Tamponade requires immediate drainage 1. For inflammatory causes, anti-inflammatory therapy is recommended, typically NSAIDs (ibuprofen 600mg TID or colchicine 0.5mg BID) for 1-2 weeks with gradual tapering 1.
- Corticosteroids (prednisone 0.25-0.5mg/kg/day) should be reserved for specific indications or when other treatments fail 1. Recurrent effusions may require pericardial window creation or pericardiectomy 1.
- Specific treatment of the underlying condition is essential, particularly for neoplastic, tuberculous, or purulent effusions 1. Regular follow-up with echocardiography is recommended, with frequency determined by clinical stability and effusion severity 1.
From the Research
Diagnosis of Pericardial Effusion
- The 2015 European Society of Cardiology (ESC) guidelines recommend echocardiography as the primary diagnostic tool for pericardial effusion 2
- Echocardiography should assess the quantity and quality of pericardial fluid, collapse of cardiac chambers, respiratory variation of ventricular diameters, inferior vena cava collapsibility, and flow patterns in atrioventricular valves 3, 4
Management of Pericardial Effusion
- The 2015 ESC guidelines recommend colchicine as first-line treatment in all forms of pericarditis except for neoplastic pericardial effusion 2
- Pericardiocentesis is performed in patients with tamponade, preferably with echocardiographic guidance 4
- In patients with malignancy, pericardial window is preferred given the risk for recurrence 4
- Local intrapericardial treatment with the already inserted pigtail catheter from the diagnostic pericardial puncture can be carried out with few systemic side effects if the etiology is known 2