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PostPosted: Wed Mar 28, 2007 6:29 pm 
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Diagnosis and treatment of pericardial effusion
G Ralph Corey, MD
Ralph Shabetai, MD

UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.1 is current through December 2006; this topic was last changed on January 10, 2007. The next version of UpToDate (15.2) will be released in June 2007.


Pericardial effusion can develop in patients with acute pericarditis or may be seen as an incidental and silent finding in a variety of systemic disorders. It may have important implications for prognosis (as in patients with intrathoracic neoplasm), for diagnosis (as in myopericarditis or acute pericarditis), or for both (as in dissection of the ascending aorta).

A general overview of the diagnosis and treatment of pericardial effusion will be presented here. Issues related to specific causes of pericardial effusion (eg, neoplasm, bacterial infection, tuberculosis, postmyocardial infarction) are discussed separately in the appropriate topic reviews. The evaluation and management of acute pericarditis is also discussed separately.


Pericardial effusion can occur as a component of almost any pericardial disorder, but the majority are due to one of the following conditions:

- Acute idiopathic or viral pericarditis
- Purulent pericarditis
- Tuberculous pericarditis
- Postmyocardial infarction or cardiac surgery
- Recent or remote sharp or blunt chest trauma, including a cardiac diagnostic or interventional procedure
- HIV infection
- Malignancy, especially lung and breast cancer, Hodgkin's disease, mesothelioma
- Mediastinal radiation, recent or remote
- Collagen vascular diseases
- Dialysis and, less commonly, chronic renal failure
- Hypothyroidism, especially myxedema

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Frequency of different etiologies The frequency of the different causes of pericardial effusion varies in published reports, depending in part upon geography, the patient population, and the indications for pericardiocentesis and pericardial biopsy (see below) (show table 2). For example, patients with HIV are more likely than other populations to have tuberculous pericarditis [1].

From a consecutive series of patients who underwent echocardiography at a single institution over a six year period, 322 patients were found to have a moderate to large pericardial effusion. Among these patients, the most common causes were [2]:

- Acute idiopathic pericarditis 20 percent
- Iatrogenic 16 percent
- Malignancy 13 percent
- - Chronic idiopathic effusion 9 percent
- Post-acute myocardial infarction (MI) 8 percent
- Uremia 6 percent
- Collagen vascular disease 5 percent


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PostPosted: Fri Jun 12, 2015 1:48 pm 

Joined: Tue Mar 03, 2015 11:57 am
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