Pericardial effusion

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Pericardial effusion
Pericardial effusion with tamponade (cropped).gif
A 2D transthoracic echocardiogram of pericardial effusion. The "swinging" heart
SpecialtyCardiac surgery
SymptomsChest pain, shortness of breath, tiredness[1]
ComplicationsCardiac tamponade[1]
Usual onsetSudden, gradual[1]
TypesTransudate, exudate, bloody[1]
Diagnostic methodUltrasound of the heart[1]
Differential diagnosisPericarditis, pulmonary edema, dilated cardiomyopathy, constrictive pericarditis, pulmonary embolism[1]
TreatmentConservative management, pericardiocentesis[1]
FrequencyRelatively common[1]

Pericardial effusion is an abnormal accumulation of fluid in the pericardial space around the heart.[1] Symptoms may include chest pain, shortness of breath, and tiredness.[1] Onset may be sudden or gradual.[1] Complications may include cardiac tamponade with low blood pressure, fast heart rate, jugular venous distension, and distant heart sounds.[1]

Causes include infections, autoimmune disorders, cancer, trauma, following a heart attack, thoracic aortic dissection, kidney failure, low thyroid, and cirrhosis.[1] In the developed world the most common cause is viral pericarditis.[1] Diagnosis is confirmed by ultrasound of the heart.[1] Normal levels of pericardial fluid are from 15 to 50 ml.[1]

Treatment depends on the underlying cause, size of the effusion, and a person's symptoms.[1] Small effusions may be managed conservatively while large effusions may be treated with pericardiocentesis.[1] Pericardial effusions are relatively common.[1] Pericardial effusions were first described around 200 AD by Galen.[2]

Signs and symptoms

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication; signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds.

It can be associated with dullness to percussion over the left subscapular area due to compression of the left lung base. This phenomenon is known as Ewart's sign.[3]

Causes

Diagnosis

It may be:

The most common causes of pericardial effusion have changed over time and vary depending on geography and the population in question. When pericardial effusion is suspected, echocardiography usually confirms the diagnosis and allows assessment for signs of hemodynamic instability. Cross-sectional imaging with computed tomography (CT) can help to localize and quantify (as in a loculated effusion) or assess for pericardial pathology (pericardial thickening, constrictive pericarditis).[7]

The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.

Treatment

Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without the treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as lupus, treatment with anti-inflammatory medications may help. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space called pericardiocentesis. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by cutting through the pericardium creating a pericardial window.[citation needed]

Other animals

Serous exsudate (arrow) in poultry parent flock with fowl cholera

Serous exsudates are seen at necropsy in various diseases of domestic animals, like enterotoxemia in sheep or fowl cholera.

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Willner, DA; Goyal, A; Grigorova, Y; Kiel, J (January 2020). "Pericardial Effusion". PMID 28613741. Cite journal requires |journal= (help)
  2. Marx, John; Hockberger, Robert; Walls, Ron (2013). Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book: 2-Volume Set. Elsevier Health Sciences. p. 1091. ISBN 978-1-4557-4987-4.
  3. "Pericardial Disease".
  4. Hallewell RA, Sherratt DJ (1976). "Isolation and characterization of Co1E2 plasmid mutants unable to kill colicin-sensitive cells". Mol Gen Genet. 146 (3): 239–45. doi:10.1007/bf00701246. PMID 794689.
  5. 5.0 5.1 Ünal, Emre; Karcaaltincaba, Musturay; Akpinar, Erhan; Ariyurek, Orhan Macit (December 2019). "The imaging appearances of various pericardial disorders". Insights into Imaging. 10 (1): 42. doi:10.1186/s13244-019-0728-4. ISSN 1869-4101. PMC 6441059. PMID 30927107.
  6. Pericardial effusion:What are the symptoms?, Dr. Martha Grogan M.D.
  7. Chang, S (Jul–Sep 2014). "Brief Images: Massive pericardial effusion". Images in Paediatric Cardiology. 16 (3): 1–3. PMC 4521324. PMID 26236369.
  8. "UOTW #25 - Ultrasound of the Week". Ultrasound of the Week. 11 November 2014. Retrieved 27 May 2017.

External links

Classification
External resources