What are the causes of pericardial effusion?

From the Guidelines

Pericardial effusion is primarily caused by conditions such as infections, autoimmune disorders, malignancies, and iatrogenic factors, which lead to fluid accumulation in the pericardial space surrounding the heart. The causes of pericardial effusion can be diverse, including:

• Infections (viral, bacterial, fungal, or tuberculous) [ 1 ]
• Autoimmune disorders (such as lupus, rheumatoid arthritis, and scleroderma) [ 1 ]
• Malignancies (particularly lung cancer, breast cancer, lymphoma, and leukemia) [ 1 ]
• Iatrogenic factors (post-cardiac surgery or radiation therapy) [ 1 ]
• Other significant causes include myocardial infarction, uremia in kidney failure, hypothyroidism, trauma to the chest, and certain medications like hydralazine, procainamide, and phenytoin [ 2 ]
• Idiopathic pericardial effusion occurs when no specific cause can be identified [ 2 ]

The pathophysiology involves inflammation of the pericardium leading to increased production of pericardial fluid, decreased reabsorption, or both [ 2 ]. The severity of symptoms depends on how quickly the fluid accumulates, with rapid accumulation causing more severe symptoms due to cardiac tamponade, while slow accumulation may allow the pericardium to stretch and accommodate larger volumes with minimal symptoms [ 1 ]. Management depends on identifying and treating the underlying cause while monitoring for signs of hemodynamic compromise [ 2 ]. According to the most recent and highest quality study [ 1 ], pericardiocentesis should be carried out for cardiac tamponade, large pericardial effusions (≥ 2cm), or for diagnostic purposes. Factors that carried poorer prognosis for 2-year survival after pericardiocentesis for malignant effusions included age > 65 years, platelet counts < 20,000, lung cancer, presence of malignant cells in the effusion, and drainage duration [ 1 ].

From the Research

Causes of Pericardial Effusion

The causes of pericardial effusion can be divided into several categories, including:

• Inflammatory causes, such as viral, bacterial, or fungal infections, and autoimmune diseases 3, 4, 5, 6
• Non-inflammatory causes, such as malignancy, renal failure, radiation, aortic dissection, and hypothyroidism 3, 4, 5, 6
• Traumatic causes, such as trauma or acute myocardial infarction 3, 4
• Idiopathic causes, where the cause of the pericardial effusion is unknown 3, 4, 5, 6
• Neoplastic causes, where the pericardial effusion is related to cancer, either directly or indirectly through radiation therapy or systemic tumor treatment 7

Specific Causes

Some specific causes of pericardial effusion include:

• Viral infections, such as tuberculosis 4, 6
• Bacterial infections, such as pneumonia 4
• Fungal infections, such as histoplasmosis 4
• Autoimmune diseases, such as rheumatoid arthritis or lupus 4, 6
• Malignancies, such as breast or lung cancer, or mediastinal lymphoma 7
• Radiation therapy, which can cause pericardial effusion as a side effect 7
• Renal failure, which can cause pericardial effusion due to fluid overload 3, 4
• Hypothyroidism, which can cause pericardial effusion due to fluid overload 3, 4

Diagnosis and Treatment

The diagnosis of pericardial effusion is typically made using echocardiography, and treatment is targeted at the underlying cause of the effusion 3, 4, 5, 6. In some cases, pericardiocentesis may be necessary to drain the fluid and relieve symptoms 3, 4, 5, 6.