Each patient was assessed by a comprehensive preoperative evaluation followed by subxiphoid pericardiotomy. The prevalence of cardiac tamponade was not reported. The prognosis was strongly determined by the patients' underlying disease, and was particularly poor in patients with neoplastic pericardial effusion, none of whom survived longer than five months after the initial pericardial drainage.Ĭorey and associates 4 investigated the aetiology of pericardial effusion in 57 patients. The most frequent causes of pericardial effusion were: neoplastic (36%), idiopathic (32%), and uraemic (20%). Of these patients, 44% presented with cardiac tamponade.
#TRIVIAL PERICARDIAL EFFUSION SERIES#
The series by Colombo and colleagues 3 included 25 male patients, all of whom were submitted to an invasive pericardial procedure.
#TRIVIAL PERICARDIAL EFFUSION PLUS#
In the series by Sagristà-Sauleda and colleagues 5 moderate effusions were defined as an echo-free space of anterior plus posterior pericardial spaces of 10–20 mm during diastole, and severe effusions as a sum of echo-free spaces greater than 20 mm. These three studies (table 1) are prospective and were done in general medical centres, but differ in respect to the criteria used to define a pericardial effusion as large, in the number of patients included and, in particular, in the study protocol applied to the patients.Ĭolombo and colleagues 3 consider effusions greater than 10 mm by M mode echocardiography as large, whereas Corey and associates 4 considered large effusions if they were greater than 5 mm. Only three major studies 3-5 have addressed one of the most common clinical problems-the aetiology of large pericardial effusion of unknown origin. 2 In addition, pericardial effusion of varying degrees can be seen in other conditions such as neoplasia (with or without direct pericardial involvement), myxoedema, renal insufficiency, pregnancy, aortic or cardiac rupture, trauma, chylopericardium, or in the setting of chronic salt and water retention of many causes, including chronic heart failure, nephrotic syndrome, and hepatic cirrhosis. All types of acute pericarditis (inflammatory, infectious, immunologic or of physical origin) can be associated with pericardial effusion. In addition, some comments on the management of neoplastic pericardial effusion are also provided.Īetiologic spectrum and prognosis of moderate and large pericardial effusionĪ wide variety of conditions may result in pericardial effusion. The main goal of this article is to give a comprehensive review of aetiology, haemodynamic findings, and management of pericardial effusion. These uncertainties have led to a heterogeneous approach to the management of the syndrome of pericardial effusion by different groups of investigators.
This is especially relevant in cases of large pericardial effusions, in which echocardiographic recordings not infrequently show findings suggestive of subclinical haemodynamic derangement, mainly right atrial or right ventricular wall collapse. In these cases, the main issues are aetiology, the clinical course, and the possibility of evolution to haemodynamic embarrassment. On other occasions, pericardial effusion is an unexpected finding that requires specific evaluation.
Sometimes, its cause is obviously related to an underlying general or cardiac disease, or to a syndrome of inflammatory or infectious acute pericarditis. Pericardial effusion is a common finding in everyday practice.
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