II. Definition

  1. Fluid collection around heart within pericardial sac

III. Causes

  1. Pericarditis
    1. See Pericarditis Causes
    2. Connective Tissue Disease (esp. Rheumatoid Arthritis)
    3. Malignancy (common, occurs in 20-40% of cancer patients)
      1. Also occurs as a complication of combination Chemotherapy, Radiation Therapy
      2. Lung Cancer
      3. Esophageal Cancer
      4. Breast Cancer
      5. Lymphoma
      6. Leukemia
      7. Melanoma
  2. Hemopericardium
    1. Heart surgery from post-operative Hemorrhage (common)
    2. Myocardial Infarction (free wall ventricular rupture)
    3. Aortic aneurysm
    4. Aortic Dissection
    5. Chest Trauma (especially penetrating Chest Injury)
    6. Anticoagulation
  3. Chylopericardium (milky Pericardial Effusion)
    1. Heart surgery from post-operative lymph collection
    2. Malignancy (lymphatic obstruction from heart)

IV. Symptoms: Symptoms

  1. Symptomatic threshold for Pericardial Effusion
    1. Acute (rapidly progressive): 200 ml
    2. Chronic: May not be significantly symptomatic until 1-2 Liters are present
  2. Common Symptoms
    1. Chest Pain
    2. Shortness of Breath
    3. Palpitations

V. Signs

  1. See Cardiac Tamponade
  2. Pulsus Paradoxus
    1. Occurs in 77% of Cardiac Tamponade cases
  3. Beck Triad (more common in rapidly progressive Pericardial Effusions)
    1. Muffled heart sounds
    2. Hypotension
    3. Jugular Venous Distention

VI. Diagnostics: Electrocardiogram

  1. See Cardiac Tamponade
  2. Low amplitude wave forms
  3. Electrical alternans

VII. Imaging: Echocardiogram

  1. See Echocardiogram
  2. Features
    1. Pericardial Effusion will surround the heart and should be seen in multiple views
    2. Pericardial fluid moves in opposite direction as heart wall
    3. Cardiac Tamponade
      1. Right heart wall movement appears as a paradoxical rocking motion
      2. Right atrium collapse in systole (also occurs with hypovolemic shock)
      3. Right ventricular collapse in diastole
      4. May appear as a tiny man jumping on right ventricle like a trampoline (PLAX View)
  3. Differential diagnosis (look-alikes on Echocardiogram, confirm in multiple views)
    1. Descending aorta
    2. Pericardial fat pad (moves with heart wall)
      1. Clotted blood may have similar heterogeneous appearance as fat
      2. However clotted blood moves independently of heart wall
  4. Precautions
    1. Even a small Pericardial Effusion (0.5 cm) can cause tamponade
  5. References
    1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete's Beach
    2. Orman, Dawson and Mallin in Majoewsky (2013) EM:Rap 13(1): 4-6

VIII. Management

  1. Consult cardiothoracic surgery
  2. Emergent management for Cardiac Tamponade
    1. See Emergency Pericardiocentesis
  3. Chronic management
    1. Pericardial window
    2. Pericardiocentesis with indwelling pericardial catheter drainage
    3. Specific cause management (e.g. Chemotherapy)
    4. Consult oncology, Palliative Care when appropriate

IX. Prognosis

  1. Malignant Pericardial Effusion
    1. Median survival: 130-140 days

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Pericardial effusion (C0031039)

Definition (NCI_CTCAE) A disorder characterized by fluid collection within the pericardial sac, usually due to inflammation.
Definition (NCI_CDISC) Fluid collection within the pericardial sac, usually due to inflammation. (NCI)
Definition (NCI) Fluid collection within the pericardial sac, usually due to inflammation.
Definition (NCI_NCI-GLOSS) An abnormal collection of fluid inside the sac that covers the heart.
Definition (MSH) Fluid accumulation within the PERICARDIUM. Serous effusions are associated with pericardial diseases. Hemopericardium is associated with trauma. Lipid-containing effusion (chylopericardium) results from leakage of THORACIC DUCT. Severe cases can lead to CARDIAC TAMPONADE.
Concepts Disease or Syndrome (T047)
MSH D010490
SnomedCT 70370001, 373945007
English Effusions, Pericardial, Pericardial Effusion, Pericardial Effusions, Effusion, Pericardial, Pericardial effusions, pericardial effusion (diagnosis), pericardial effusion, Effusion pericardial, Pericardial Fluid, Pericardial Effusion [Disease/Finding], pericardial effusions, effusion pericardial, Fluid in pericardium, PERICARDIAL EFFUSION, FLUID, PERICARDIAL, Pericardial effusion (disorder), effusion; pericardial, effusion; pericardium, pericardium; effusion, Pericardial effusion, NOS, Pericardial effusion
Portuguese DERRAME PERICARDICO, Derrame pericárdico, Derrame Pericárdico
Spanish DERRAME PERICARDICO, derrame pericárdico (trastorno), derrame pericárdico, Derrame pericárdico, Derrame Pericárdico
Japanese 心嚢液貯留, シンノウエキチョリュウ
Swedish Perikardiell utgjutning
Czech perikardiální efúze, Perikardiální výpotek, Výpotek perikardiální
Finnish Perikardiumeffuusio
Russian PERIKARDIAL'NYI VYPOT, GEMOPERIKARD, ГЕМОПЕРИКАРД, ПЕРИКАРДИАЛЬНЫЙ ВЫПОТ
French EFFUSION PERICARDIQUE, Epanchement péricardique, Épanchement péricardique
German PERICARDIALERGUSS, Perikarderguss, Herzbeutelerguß, Perikarderguß
Polish Wysięk osierdziowy, Krwiak osierdzia
Hungarian Pericardialis fluidum, Pericardialis effusio
Norwegian Perikardial effusjon, Perikardial lekkasje
Dutch effusie; pericard, pericard; effusie, vochtophoping; pericard, pericardeffusie, Effusie, pericard-, Pericardeffusie
Italian Versamento pericardico