From the Guidelines
For moderate-sized pericardial effusions, treatment should be targeted at the underlying cause, and when symptomatic, pericardiocentesis with prolonged drainage may be considered to promote adherence of pericardial layers and prevent further fluid accumulation, as recommended by the 2015 ESC guidelines 1.
Treatment Approach
When the effusion is associated with pericarditis, management should follow that of pericarditis. However, when a pericardial effusion becomes symptomatic without evidence of inflammation, or when empiric anti-inflammatory drugs are not successful, drainage of the effusion should be considered.
- Pericardiocentesis with prolonged pericardial drainage of up to 30 ml/24 h may be considered to promote adherence of pericardial layers and prevent further accumulation of fluid.
- In the absence of inflammation, NSAIDs, colchicine, and corticosteroids are generally not effective in reducing an isolated effusion, as stated in the 2015 ESC guidelines 1.
Management Considerations
- Pericardiocentesis alone may be necessary for the resolution of large effusions, but recurrences are also common.
- Pericardiectomy or less invasive options, such as a pericardial window, should be considered whenever fluid reaccumulates, becomes loculated, or biopsy material is required, as suggested by the 2015 ESC guidelines 1.
Key Points
- Treatment of moderate-sized pericardial effusion should focus on the underlying cause and symptoms.
- Pericardiocentesis with prolonged drainage may be considered for symptomatic patients without evidence of inflammation.
- Regular monitoring and follow-up are necessary to assess treatment response and prevent complications.
From the Research
Treatment Options for Moderate Sized Pericardial Effusion
- Pericardiocentesis is a common treatment option for moderate sized pericardial effusion, especially if there is a risk of tamponade or if the patient is experiencing symptoms 2, 3.
- Echocardiography-guided pericardiocentesis is the preferred method for resolving cardiac tamponade 4.
- Medical treatment of pericardial effusion is mainly dictated by the presence of inflammatory signs and by the underlying disease if present 3.
- Colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis after pericardiocentesis or pericardiotomy 5, 4.
- NSAIDs can also be considered to prevent recurrence and effusive-constrictive pericarditis after pericardiocentesis or pericardiotomy 4.
Considerations for Treatment
- The size of the effusion, the presence of tamponade, and the underlying cause of the effusion should be taken into account when deciding on a treatment plan 2, 3.
- Patients with malignancy may require a pericardial window due to the risk of recurrence 2, 3.
- Patients with chronic massive idiopathic pericardial effusion may require pericardial drainage due to the risk of developing unexpected tamponade 3.
- The selection of the pericardial drainage procedure depends on the etiology of the effusion 3.
Diagnostic Considerations
- Echocardiography is essential to define the location and size of the effusion 2.
- Imaging techniques such as chest X-ray, electrocardiogram, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis can be used to evaluate pericardial effusion 6.
- The diagnosis of pericardial effusion should be based on a combination of clinical findings, imaging results, and laboratory tests 2, 3.