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    Pericardial Effusion

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    Nita Hurek
    Pericardial effusion occurs when excess fluid collects in the pericardial space, which normally contains 30-50mL of fluid. There is no single demographic affected as there are many underlying causes. Clinical presentation depends more on the speed of fluid accumulation than volume, as slow accumulation allows stretching. Symptoms relate to impaired cardiac function from increased intrapericardial pressure. Echocardiography is the preferred method to confirm diagnosis, estimate volume, and assess hemodynamic impact. Treatment options include conservative management for small, asymptomatic effusions or pericardiocentesis to drain large or symptomatic effusions.

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    Pericardial Effusion

    Uploaded by

    Nita Hurek
    161 views3 pages
    Pericardial effusion occurs when excess fluid collects in the pericardial space, which normally contains 30-50mL of fluid. There is no single demographic affected as there are many underlying causes. Clinical presentation depends more on the speed of fluid accumulation than volume, as slow accumulation allows stretching. Symptoms relate to impaired cardiac function from increased intrapericardial pressure. Echocardiography is the preferred method to confirm diagnosis, estimate volume, and assess hemodynamic impact. Treatment options include conservative management for small, asymptomatic effusions or pericardiocentesis to drain large or symptomatic effusions.

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    Pericardial effusion occurs when excess fluid collects in the pericardial space, which normally contains 30-50mL of fluid. There is no single demographic affected as there are many underlying causes. Clinical presentation depends more on the speed of fluid accumulation than volume, as slow accumulation allows stretching. Symptoms relate to impaired cardiac function from increased intrapericardial pressure. Echocardiography is the preferred method to confirm diagnosis, estimate volume, and assess hemodynamic impact. Treatment options include conservative management for small, asymptomatic effusions or pericardiocentesis to drain large or symptomatic effusions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    161 views3 pages

    Pericardial Effusion

    Uploaded by

    Nita Hurek
    Pericardial effusion occurs when excess fluid collects in the pericardial space, which normally contains 30-50mL of fluid. There is no single demographic affected as there are many underlying causes. Clinical presentation depends more on the speed of fluid accumulation than volume, as slow accumulation allows stretching. Symptoms relate to impaired cardiac function from increased intrapericardial pressure. Echocardiography is the preferred method to confirm diagnosis, estimate volume, and assess hemodynamic impact. Treatment options include conservative management for small, asymptomatic effusions or pericardiocentesis to drain large or symptomatic effusions.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    At a glance
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    The key takeaways are that a pericardial effusion occurs when excess fluid collects in the pericardial space around the heart and can have various causes such as infection, cancer, or injury. Symptoms depend on the rate of fluid accumulation.

    Common causes of pericardial effusions include infection, cancer (either primary or metastatic), connective tissue diseases, hypothyroidism, myocardial infarction, pulmonary hypertension, and trauma or surgery.

    Pericardial effusions can be detected using imaging tests such as chest x-rays, echocardiograms, and CT scans. Imaging can confirm the diagnosis, estimate fluid volume, and assess the impact on heart function.

    Pericardial effusion

    Dr Henry Knipe and A.Prof Frank Gaillard et al.

    Pericardial effusions occur when excess fluid collects in the pericardial


    space (a normal pericardial sac contains approximately 30-50 mL of fluid).

    Epidemiology
    There is no single demographic affected, as there are many underlying causes of
    a pericardial effusion.

    Clinical presentation
    Clinical presentation of pericardial effusions does not relate so much to the size
    of the effusion but rather the speed at which the fluid has accumulated, as slow
    gradual accumulation allows the pericardium to stretch and accomodate much
    larger volumes of fluid . 4

    Regardless of volume, symptoms relate to impaired cardiac function due to


    intrapericardial pressure approximating intracardiac pressure leading to impaired
    filling of low pressure chambers, particularly the right atrium.

    Dyspnoea and reduced exercise tolerance will be early signs, progressing to


    severe impaired cardiac output and death in severe cases (e.g. cardiac
    tamponade).

    Pathology
    Aetiology
    idiopathic
    inflammatory
    o post myocardial infarction: Dressler syndrome
    o connective tissue disorders
    infectious
    o viral
    o bacterial
    o tuberculosis
    post surgical / trauma
    pulmonary arterial hypertension 7

    radiotherapy
    malignancy
    o primary, e.g pericardial mesothelioma
    o metastatic
    endocrine
    o hypothyroidism 3

    Radiographic features
    Plain radiograph
    a very small pericardial effusion can be occult on plain film
    there can be globular enlargement of the cardiac shadow giving a water bottle
    configuration
    lateral CXR may show a vertical opaque line (pericardial fluid) separating a
    vertical lucent line directly behind sternum (epicardial fat) anteriorly from a
    similar lucent vertical lucent line (pericardial fat) posteriorly; this is known as
    the Oreo cookie sign 5

    widening of the subcarinal angle without other evidence of left atrial


    enlargement may be an indirect clue 2

    a differential density sign at cardiac borders has been suggested , but its
    9

    specificity is limited

    Echocardiography
    Echocardiography is the method of choice to confirm the diagnosis, estimate the
    volume of fluid and most importantly assess the haemodynamic impact of the
    effusion.

    CT
    The generally accepted thickness of a normal pericardium, measured on CT
    scans and on MR images is often taken at 2 mm . 6

    CT makes the diagnosis extremely easy, but is usually obtained to try and clarify
    the cause of an effusion rather than to confirm the diagnosis. Pericardial
    effusions are a frequent incidental finding in unwell hospitalised patients.
    Fluid density material is seen surrounding the heart. Careful inspection of the
    region is necessary to ensure that no invasive mass can be identified.

    Estimating volume
    Depth of the effusion can be used to estimate the likely volume of fluid, provided
    the fluid is relatively evenly spread throughout the pericardium (global effusion) .
    4

    Clearly this does not apply to localised effusions.

    <5 mm: 50-100 mL


    5-10 mm: 100-250 mL
    10-20 mm: 250-500 mL
    >20 mm: >500 mL

    Treatment and prognosis


    If small, asymptomatic and clinically not-suspect then conservative management
    is usually favoured.

    If large, symptomatic or there is clinical concern of the underlying cause (e.g.


    infection, malignancy) then pericardiocentesis can be performed to drain the
    fluid. A Seldinger technique is employed, usually under
    ultrasound/echocardiographic guidance, to insert a drain into the pericardial
    space . 4

    In cases where effusions are recurrent and symptomatic (e.g. malignancy)


    then pericardial fenestration can be performed.

    Differential diagnosis
    haemopericardium: has higher attenuation on CT and often a different clinical
    context
    cardiomegaly: can sometimes mimic an effusion

    sumber : https://radiopaedia.org/articles/pericardial-effusion

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