From the Guidelines
Treatment for small pericardial and pleural effusions should be targeted at the underlying cause, and diuretics, supportive care, and consideration of a short course of steroids if significant symptoms are present, are recommended. The management of these effusions depends on their etiology, and in about 60% of cases, the effusion is associated with a known disease, and the essential treatment is that of the underlying disease 1.
Key Considerations
- The use of diuretics, such as furosemide, can help reduce fluid accumulation in the pericardial and pleural spaces 1.
- If the patient has significant symptoms, a short course of steroids, such as prednisone, may be considered 1.
- Rest and monitoring are essential components of management, and patients should be monitored with follow-up echocardiograms and chest imaging to ensure resolution of the effusions.
- If the effusions are due to infection, appropriate antibiotics are necessary, and for inflammatory causes, corticosteroids may be used if NSAIDs are ineffective.
Treatment Approach
- Diuretics and supportive care are the initial treatment approach, and the use of NSAIDs, such as ibuprofen or aspirin, may not be effective in reducing the effusion in the absence of inflammation 1.
- Pericardiocentesis or thoracentesis may be required if symptoms worsen or effusions increase in size, and pericardial drainage is recommended in all patients with large effusions due to the high recurrence rate 1.
- Intrapericardial instillation of cytostatic/sclerosing agents may be considered to prevent recurrences, and the type of treatment should be tailored to the type of tumor, if the effusion is due to a malignant process 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Small Pericardial Effusion with Small Pleural Effusion
- A small, asymptomatic pleural effusion of known etiology can be treated conservatively, mostly by treating the underlying cause and with careful observation for signs or symptoms of deterioration 2.
- For patients with a small pericardial effusion, the treatment approach depends on the presence of hemodynamic compromise or cardiac tamponade 3, 4.
- In cases where there is no significant hemodynamic compromise, medical treatment may be sufficient, and pericardial drainage may not be necessary 4.
- However, if there is a risk of developing unexpected tamponade, such as in patients with chronic massive idiopathic pericardial effusion, pericardial drainage may be indicated 4.
- The combination of a large pleural effusion and a small pericardial effusion can result in cardiac tamponade, and treatment should be aimed at addressing both conditions 3.
- Echocardiography plays a key role in the management of cardiac tamponade and should be consulted when making final treatment decisions 5.
Pericardial Drainage Procedures
- Simple pericardiocentesis is usually sufficient in patients with acute idiopathic or viral pericarditis 4.
- Purulent pericarditis should be drained surgically, usually through subxiphoid pericardiotomy 4.
- Neoplastic pericardial effusion constitutes a more difficult challenge, and therapeutic possibilities include extended indwelling pericardial catheter, percutaneous pericardiostomy, and intrapericardial instillation of antineoplastic and sclerosing agents 4.
- Massive chronic idiopathic pericardial effusions may require wide anterior pericardiectomy 4.
Pleural Effusion Treatment
- Pleural effusions associated with pericarditis are usually small, bilateral, and exudative, and treatment refractory cases may require pleural intervention, such as aspirations, drains, and indwelling pleural catheters (IPCs) 6.