eMedicine Specialties > Cardiology > Pericardial Disease

Pericardial Effusion: Multimedia

Author: William J Strimel, DO, Fellow, Cardiovascular Disease, Scott and White Memorial Hospital
Coauthor(s): Ramin Assadi, MD, Staff Physician, Department of Internal Medicine, Loma Linda University; Ali A Sovari, MD, Research Fellow, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA); Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Sep 9, 2008

Multimedia

Image is from a patient with malignant pericardia...
(Enlarge Image)
Media file 1: Image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film.
[ CLOSE WINDOW ]
Image is from a patient with malignant pericardia...

Image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film.

Echocardiogram (parasternal, long axis) of a pati...
(Enlarge Image)
Media file 2: Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.
[ CLOSE WINDOW ]
Echocardiogram (parasternal, long axis) of a pati...

Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.

This image is from the same patient with malignan...
(Enlarge Image)
Media file 3: This image is from the same patient with malignant pericardial effusion shown in Images 1 and 4. The effusion is seen as an echo-free region to the right of the left ventricle (LV).
[ CLOSE WINDOW ]
This image is from the same patient with malignan...

This image is from the same patient with malignant pericardial effusion shown in Images 1 and 4. The effusion is seen as an echo-free region to the right of the left ventricle (LV).

This ECG is from the same patient with malignant ...
(Enlarge Image)
Media file 4: This ECG is from the same patient with malignant pericardial effusion shown in Images 1 and 3. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.
[ CLOSE WINDOW ]
This ECG is from the same patient with malignant ...

This ECG is from the same patient with malignant pericardial effusion shown in Images 1 and 3. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.

More on Pericardial Effusion

Overview: Pericardial Effusion
Differential Diagnoses & Workup: Pericardial Effusion
Treatment & Medication: Pericardial Effusion
Follow-up: Pericardial Effusion
Multimedia: Pericardial Effusion
References
[ CLOSE WINDOW ]

References

  1. Montaudon M, Roubertie F, Bire F, Laurent F. Congenital pericardial defect: report of two cases and literature review. Surg Radiol Anat. Apr 2007;29(3):195-200. [Medline].

  2. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. Jan 2007;60(1):27-34. [Medline].

  3. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. Oct 2002;74(4):1148-53. [Medline].

  4. Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest. Aug 1999;116(2):322-31. [Medline].

  5. Ciliberto GR, Anjos MC, Gronda E, Bonacina E, Danzi G, Colombo P, et al. Significance of pericardial effusion after heart transplantation. Am J Cardiol. Aug 1 1995;76(4):297-300. [Medline].

  6. Hoit BD. Pericardial disease and pericardial tamponade. Crit Care Med. Aug 2007;35(8 Suppl):S355-64. [Medline].

  7. Karia DH, Xing YQ, Kuvin JT, Nesser HJ, Pandian NG. Recent role of imaging in the diagnosis of pericardial disease. Curr Cardiol Rep. Jan 2002;4(1):33-40. [Medline].

  8. Taguchi R, Takasu J, Itani Y, Yamamoto R, Yokoyama K, Watanabe S, et al. Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis. Jul 2001;157(1):203-9. [Medline].

  9. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. Nov 2005;90(11):6300-2. [Medline].

  10. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. Sep 27 2005;112(13):2012-6. [Medline].

  11. Allen KB, Faber LP, Warren WH. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg. Feb 1999;67(2):437-40. [Medline].

  12. Artom G, Koren-Morag N, Spodick DH, Brucato A, Guindo J, Bayes-de-Luna A, et al. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis. Eur Heart J. Apr 2005;26(7):723-7. [Medline].

  13. Barbaro G. Cardiovascular manifestations of HIV infection. Circulation. Sep 10 2002;106(11):1420-5. [Medline].

  14. Moore KL, Persaud TVN. Before We Are Born: Essentials of Embryology and Birth Defects. 4th ed. 1993.

  15. Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. May 2000;21(10):832-6. [Medline].

  16. Braunwald E. Cardiology: how did we get here, where are we today and where are we going?. Can J Cardiol. Oct 2005;21(12):1015-7. [Medline].

  17. Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders Company; 1997:1478-96.

  18. Cheitlin MD, Alpert JS, Armstrong WF. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in coll. Circulation. Mar 18 1997;95(6):1686-744. [Medline].

  19. Chen Y, Brennessel D, Walters J. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J. Mar 1999;137(3):516-21. [Medline].

  20. Chong HH, Plotnick GD. Pericardial effusion and tamponade: evaluation, imaging modalities, and management. Compr Ther. Jul 1995;21(7):378-85. [Medline].

  21. Eisenberg MJ, de Romeral LM, Heidenreich PA. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. Aug 1996;110(2):318-24. [Medline].

  22. Fagan SM, Chan KL. Pericardiocentesis: blind no more! [editorial; comment]. Chest. Aug 1999;116(2):275-6. [Medline].

  23. Feigenbaum, H. Echocardiography. 1994. 5th ed. Philadelphia: Lea & Febiger; 556-74.

  24. Flores RM, Jaklitsch MT, DeCamp MM Jr. Video-assisted thoracic surgery pericardial resection for effusive disease. Chest Surg Clin N Am. Nov 1998;8(4):835-51. [Medline].

  25. Guberman BA, Fowler NO, Engel PJ. Cardiac tamponade in medical patients. Circulation. Sep 1981;64(3):633-40. [Medline].

  26. Heidenreich PA, Eisenberg MJ, Kee LL. Pericardial effusion in AIDS. Incidence and survival. Circulation. Dec 1 1995;92(11):3229-34. [Medline].

  27. Ilan Y, Oren R, Ben-Chetrit E. Etiology, treatment, and prognosis of large pericardial effusions. A study of 34 patients. Chest. Oct 1991;100(4):985-7. [Medline].

  28. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. Dec 17 2003;42(12):2144-8. [Medline].

  29. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. Mar 17 2004;43(6):1042-6. [Medline].

  30. Kasper D, Branunwald E, Fauci A, et al. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill Professional; 2005:1414-1420.

  31. Kimberly RP. Treatment. Corticosteroids and anti-inflammatory drugs. Rheum Dis Clin North Am. Apr 1988;14(1):203-21. [Medline].

  32. Kocheril AG, Luttmann C, Sadaniantz A. Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics. Cathet Cardiovasc Diagn. Dec 1991;24(4):286-7. [Medline].

  33. Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med. Nov 18 2004;351(21):2195-202. [Medline].

  34. Little WC, Freeman GL. Pericardial disease. Circulation. Mar 28 2006;113(12):1622-32. [Medline].

  35. Maher EA, Shepherd FA, Todd TJ. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg. Sep 1996;112(3):637-43. [Medline].

  36. Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment. Curr Opin Cardiol. May 1994;9(3):379-88. [Medline].

  37. Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. Oct 2002;23(19):1503-8. [Medline].

  38. Mangan CM. Malignant pericardial effusions: pathophysiology and clinical correlates. Oncol Nurs Forum. Sep 1992;19(8):1215-21. [Medline].

  39. Maruyama R, Yokoyama H, Seto T, Nagashima S, Kashiwabara K, Araki J, et al. Catheter drainage followed by the instillation of bleomycin to manage malignant pericardial effusion in non-small cell lung cancer: a multi-institutional phase II trial. J Thorac Oncol. Jan 2007;2(1):65-8. [Medline].

  40. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. Dec 6 2005;112(23):3608-16. [Medline].

  41. Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. Oct 1999;138(4 Pt 1):759-64. [Medline].

  42. Meyers DG, Bagin RG, Levene JF. Electrocardiographic changes in pericardial effusion. Chest. Nov 1993;104(5):1422-6. [Medline].

  43. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest. May 1997;111(5):1213-21. [Medline].

  44. Naqvi TZ, Huynh HK. A new window of opportunity in echocardiography. J Am Soc Echocardiogr. May 2006;19(5):569-77. [Medline].

  45. Nugue O, Millaire A, Porte H. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. Oct 1 1996;94(7):1635-41. [Medline].

  46. Pankuweit S, Ristic AD, Seferovic PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005;5(2):103-12. [Medline].

  47. Press OW, Livingston R. Management of malignant pericardial effusion and tamponade. JAMA. Feb 27 1987;257(8):1088-92. [Medline].

  48. Retter AS. Pericardial disease in the oncology patient. Heart Dis. Nov-Dec 2002;4(6):387-91. [Medline].

  49. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. Dec 30 1999;341(27):2054-9. [Medline].

  50. Shabetai R. Recurrent pericarditis: recent advances and remaining questions. Circulation. Sep 27 2005;112(13):1921-3. [Medline].

  51. Silva-Cardoso J, Moura B, Martins L. Pericardial involvement in human immunodeficiency virus infection. Chest. Feb 1999;115(2):418-22. [Medline].

  52. Spodick DH. Acute pericarditis: current concepts and practice. JAMA. Mar 5 2003;289(9):1150-3. [Medline].

  53. Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion. Eur Heart J. Oct 2002;23(19):1481-2. [Medline].

  54. Spodick DH. The technique of pericardiocentesis. When to perform it and how to minimize complications. J Crit Illn. Nov 1995;10(11):807-12. [Medline].

  55. Vaitkus PT, Herrmann HC, LeWinter MM. Treatment of malignant pericardial effusion. JAMA. Jul 6 1994;272(1):59-64. [Medline].

  56. Weisse AB, Desai RR, Rajihah G. Contrast echocardiography as an adjunct in hemorrhagic or complicated pericardiocentesis. Am Heart J. Apr 1996;131(4):822-5. [Medline].

  57. Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. Mar 1984;69(3):506-11. [Medline].

  58. Zhang P, Liegeois NJ, Wong C, et al. Altered cell differentiation and proliferation in mice lacking p57KIP2 indicates a role in Beckwith-Wiedemann syndrome. Nature. May 8 1997;387(6629):151-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

pericardial effusion, pericardial sac, dropsy of pericardium, pericarditis, pericardial tamponade, pericardiocentesis, pericardioscopy, malignant pericardial effusion, leukemia, lymphoma, idiopathic effusions, Beck triad of pericardial tamponade, hypotension, muffled heart sounds, jugular venous distension

pulsus paradoxus, pericardial friction rub, hepatojugular reflux, Ewart sign, hepatosplenomegaly, cyanosis, hydropericardium, congestive heart failure, valvular disease, mediastinal lymphoma, Hodgkin disease, metastatic breast cancer, bacterial pericardial effusion, viral pericardial effusion, tuberculous pericardial effusion, parasitic pericardial effusion, HIV-related pericardial effusion, fungal pericardial effusion, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, vasculitides, uremia, postpericardiotomy syndrome, chylopericardium, myxedema, radiation-induced pericardial effusion

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

William J Strimel, DO, Fellow, Cardiovascular Disease, Scott and White Memorial Hospital
William J Strimel, DO is a member of the following medical societies: American College of Cardiology, American College of Physicians, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ramin Assadi, MD, Staff Physician, Department of Internal Medicine, Loma Linda University
Ramin Assadi, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Ali A Sovari, MD, Research Fellow, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA)
Ali A Sovari, MD is a member of the following medical societies: American College of Physicians, American Heart Association, and American Medical Association
Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Abraham G Kocheril, MD, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, Heart Rhythm Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Justin D Pearlman, MD, PhD, ME, MA, Director of Dartmouth Advanced Imaging Center, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald J Oudiz, MD, Director of Pulmonary Hypertension, Associate Professor, Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA
Ronald J Oudiz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.