Commentary - Journal of Invasive and Non-Invasive Cardiology (2023) Volume 6, Issue 4

Etiologic spectrum of moderate and large pericardial effusions

Emma Craik ^*

Department of Cardiology, University of Leibniz Hannover, Germany

*Corresponding Author:

Emma Craik
Department of Cardiology,
University of Leibniz Hannover
Germany
E-mail: e.craik@lih.lu

Received:27-Jul-2023, Manuscript No. AAMCR-23-109315;Editor assigned: 31-Jul-2023, PreQC No. AAMCR-23-109315(PQ);Reviewed:14-Aug-2023, QC No. AAMCR-23-109315;Revised:21-Aug-2023, Manuscript No. AAMCR-23-109314(R); Published:28-Aug-2023, DOI: 10.35841/ aamcr-6.4.165

Citation: Craik E. Etiologic spectrum of moderate and large pericardial effusions. J Invasive Noninvasive Cardiol. 2023;6(4):165

Abstract

Introduction

Pericardial effusion, the accumulation of fluid within the pericardial sac surrounding the heart, can result from a wide range of etiologies. Understanding the underlying causes of moderate and large pericardial effusions is crucial for accurate diagnosis and appropriate management. This article aims to explore the diverse etiologic spectrum of pericardial effusions and shed light on the diagnostic approach to these cases. Infections are a common cause of pericardial effusions. Viral infections, such as Coxsackievirus and Epstein-Barr virus, are frequently implicated. Bacterial infections, including tuberculosis and pneumococcal infections, can also lead to pericarditis and subsequent effusion. Fungal and parasitic infections are less common but should be considered, particularly in immunocompromised individuals [1].

Autoimmune and inflammatory conditions are significant contributors to pericardial effusions. Rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis are among the autoimmune disorders associated with pericarditis and effusion. Inflammatory conditions, such as acute pericarditis and Dressler syndrome (post-myocardial infarction syndrome), can also result in pericardial effusions [2].

Pericardial effusions may arise from primary or metastatic malignancies involving the pericardium or adjacent structures. Common cancers associated with pericardial effusions include lung cancer, breast cancer, and lymphomas. Effusions from malignancies tend to be hemorrhagic and may cause cardiac tamponade, a life-threatening condition requiring immediate intervention. Pericardial effusions can develop following blunt or penetrating chest trauma. Injury to the pericardium can cause bleeding or leakage of fluid into the pericardial space. Additionally, cardiac surgeries, such as coronary artery bypass grafting or valve replacements, carry a risk of postoperative pericardial effusions due to disruption of the pericardium [3].

Pericardial effusions may arise from primary or metastatic malignancies involving the pericardium or adjacent structures. Common cancers associated with pericardial effusions include lung cancer, breast cancer, and lymphomas. Effusions from malignancies tend to be hemorrhagic and may cause cardiac tamponade, a life-threatening condition requiring immediate intervention. Pericardial effusions can develop following blunt or penetrating chest trauma. Injury to the pericardium can cause bleeding or leakage of fluid into the pericardial space. Additionally, cardiac surgeries, such as coronary artery bypass grafting or valve replacements, carry a risk of postoperative pericardial effusions due to disruption of the pericardium [4].

In some cases, the cause of pericardial effusion remains unclear despite thorough evaluation. These cases are labeled as idiopathic pericardial effusions. Additionally, rare causes, such as radiation-induced pericarditis, purulent pericarditis, and aortic dissection, should be considered, although they account for a small proportion of cases. Diagnostic approach The evaluation of moderate to large pericardial effusions necessitates a systematic approach. It typically involves a thorough medical history, physical examination, laboratory investigations (including serologic tests, inflammatory markers, and tumor markers), electrocardiography, chest radiography, echocardiography, and sometimes more advanced imaging modalities like computed tomography (CT) or magnetic resonance imaging (MRI). Electrocardiography (ECG) is a valuable tool in assessing pericardial involvement. It can show diffuse ST-segment elevations suggestive of acute pericarditis, electrical alternans (alternating amplitude of QRS complexes) seen in large effusions, or signs of underlying ischemia or conduction abnormalities. Chest radiography is useful for evaluating the size and shape of the cardiac silhouette, identifying pleural effusions or pulmonary abnormalities, and detecting signs of cardiac tamponade, such as an enlarged globular heart. In cases where the etiology remains uncertain, or when additional information is needed, advanced imaging modalities like CT or MRI may be employed. These imaging techniques provide detailed anatomical information, can detect loculated or complex effusions, and help identify pericardial masses or signs of malignancy [5].

Conclusion

Moderate and large pericardial effusions have a diverse etiologic spectrum, ranging from infectious and autoimmune causes to neoplastic, traumatic, metabolic, and drug-induced factors. Accurate identification of the underlying etiology is crucial for appropriate management and targeted treatment. A systematic diagnostic approach involving detailed history-taking, physical examination, laboratory investigations, electrocardiography, chest radiography, echocardiography, and advanced imaging modalities when necessary, plays a pivotal role in unraveling the complex etiologies of pericardial effusions. Collaboration between cardiologists, internists, infectious disease specialists, oncologists, and other relevant healthcare professionals is essential for optimal patient care and outcomes.

References

1. Wei JY, Taylor GJ, Achuff SC. Recurrent cardiac tamponade and large pericardial effusions: Management with an indwelling pericardial catheter. Am J Cardiol. 1978;42:281-2.

Indexed at, Google Scholar, Cross Ref

2. Lock JE, Bass JL, Kulik TJ, et al Chronic percutaneous pericardial drainage with modified pigtail catheters in children. Am J Cardiol. 1984;53:1179-82.

Indexed at, Google Scholar,Cross Ref

3. Kopecky SL, Callahan JA, Tajik AJ, et al. Percutaneous pericardial catheter drainage: Report of 42 consecutive cases. Am J Cardiol. 1986;58:633-5.

Indexed at, Google Scholar, Cross Ref

4. Swanson N, Mirza I, Wijesinghe N, et al. Primary percutaneous balloon pericardiotomy for malignant pericardial effusion. Catheter Cardiovasc Interv. 2008;71:504-7.

Indexed at, Google Scholar, Cross Ref

5. Piehler JM, Pluth JR, Schaff HV, et al . Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course . J Thorac Cardiovasc Surg. 1985;90:506-16.

Indexed at, Google Scholar,