From the Guidelines
Pericardial effusion is interpreted based on its size, composition, and hemodynamic impact, with large effusions being more likely to cause cardiac tamponade and requiring urgent treatment 1.
Key Factors in Interpretation
- Size: Effusions can be classified as mild (<10 mm), moderate (10-20 mm), or large (>20 mm) based on echocardiographic assessment 1.
- Composition: Effusions can be transudative or exudative, with exudative effusions more likely to be caused by malignant or infectious processes 1.
- Hemodynamic Impact: Effusions can cause cardiac tamponade, which is a life-threatening condition requiring immediate treatment 1.
Diagnostic Approach
- Imaging: Echocardiography is the primary imaging modality for evaluating pericardial effusion, with CT and MRI also being useful in certain cases 1.
- Pericardial Fluid Analysis: Analysis of pericardial fluid can help establish the diagnosis of viral, bacterial, tuberculous, fungal, cholesterol, and malignant pericarditis 1.
- Cytology and Tumor Markers: Cytology and tumor markers, such as CEA and CA-125, can be useful in diagnosing malignant pericardial effusion 1.
Treatment
- Pericardiocentesis: Pericardiocentesis is a class I indication for cardiac tamponade and can also be used to relieve symptoms and establish a diagnosis in large suspected neoplastic pericardial effusion without tamponade 1.
- Intrapericardial Instillation of Cytostatic/Sclerosing Agents: Intrapericardial instillation of cytostatic/sclerosing agents can be used to prevent recurrences of malignant pericardial effusion 1.
From the Research
Interpretation of Pericardial Effusion
Pericardial effusion is interpreted based on its size, hemodynamic importance, and possible associated diseases 2. The causes of pericardial effusions are varied and include:
- Infections (viral, bacterial, especially tuberculosis) 2, 3
- Cancer 2, 3
- Connective tissue diseases 2
- Pericardial injury syndromes 2
- Metabolic causes (i.e. hypothyroidism) 2
- Myopericardial and aortic diseases 2
Diagnosis and Characterization
Diagnosis of pericardial effusion is typically made using echocardiography, which can detect the presence of excess fluid in the pericardial cavity 4, 5, 6. Characterization of the fluid and search for signs of possible cardiac tamponade are also crucial steps in the interpretation of pericardial effusion 4, 5.
Hemodynamic Compromise
The hemodynamic compromise caused by pericardial fluid is evaluated to determine the presence of cardiac tamponade, which is not an "all or none" phenomenon, but a syndrome with a continuum of severity 5. Echocardiographic tamponade is recognized by the presence of cardiac chamber collapses and characteristic alterations in respiratory variations of mitral and tricuspid flow 4, 5.
Treatment and Management
Treatment of pericardial effusion is mainly dictated by the presence of inflammatory signs and by the underlying disease if present 2, 5. Pericardial drainage is mandatory when clinical tamponade is present, and examination of the pericardial fluid is indicated when there is a clinical suspicion of purulent pericarditis or in patients with underlying neoplasia 5. Various invasive and non-invasive strategies such as pericardiocentesis, pericardial window, and sclerosing therapies are available for the management of patients with pericardial effusion 6.