Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pericardial Effusion Treatment & Management

  • Author: William J Strimel, DO, FACP; Chief Editor: Richard A Lange, MD, MBA  more...
 
Updated: Jan 03, 2016
 

Approach Considerations

Pharmacotherapy for pericardial effusion includes use of the following agents, depending on etiology:

  • Aspirin/NSAIDs
  • Colchicine
  • Steroids
  • Antibiotics

Antineoplastic therapy (eg, systemic chemotherapy, radiation) in conjunction with pericardiocentesis has been shown to be effective in reducing recurrences of malignant effusions. Corticosteroids and NSAIDs are helpful in patients with autoimmune conditions.

Pericardial sclerosis

Several pericardial sclerosing agents have been used with varying success rates (eg, tetracycline, doxycycline, cisplatin, 5-fluorouracil). The pericardial catheter may be left in place for repeat instillation if necessary until the effusion resolves.

Complications include intense pain, atrial dysrhythmias, fever, and infection. Success rates are reported to be as high as 91% at 30 days.

Surgery

Surgical treatments for pericardial effusion include the following:

  • Pericardiostomy
  • Pericardotomy
  • Thoracotomy
  • Sternotomy
  • Pericardiocentesis

Inpatient care

Patients with pericardial effusion who present with significant symptoms or cardiac tamponade require emergent treatment and admission to the intensive care unit (ICU). The pericardial catheter (if placed) should be removed within 24-48 hours to avoid infection. Symptomatic patients should remain hospitalized until definitive treatment is accomplished and/or symptoms have resolved

Outpatient care

Patients should be educated with regard to symptoms of increasing pericardial effusion and should be evaluated whenever these symptoms begin to occur. Indications for echocardiography after diagnosis include the following:

  • A follow-up imaging study to evaluate for recurrence/constriction - Repeat studies may be performed to answer specific clinical questions.
  • The presence of large or rapidly accumulating effusions - To detect early signs of tamponade

Transfer

Symptomatic patients requiring treatment (who are surgical candidates) should receive care at an institution with cardiothoracic surgery capabilities.

Consultations

A cardiologist should be involved in the care of patients with pericardial effusion. Cardiothoracic surgery may be required for recurrent or complicated cases.

Next

Aspirin/NSAIDs

Most acute idiopathic or viral pericarditis occurrences are self-limited and respond to treatment with aspirin (650 mg q6h) or another NSAID. For idiopathic or viral pericarditis, ibuprofen is preferred, given its low adverse effect profile, favorable impact on the coronary blood flow, and large dose range. Based on severity and response, the dose can range from 300-800 mg every 6-8 hours.[26]

Aspirin may be the preferred nonsteroidal agent to treat pericarditis after myocardial infarction because other NSAIDs may interfere with myocardial healing. Indomethacin should be avoided in patients who may have coronary artery disease.

In a study of 196 patients at high risk for tamponade because of pericardial effusion more than 7 days after cardiac surgery, Meurin et al found that diclofenac was not effective in reducing the size of the effusion or in preventing late cardiac tamponade. In the multicenter, randomized, double-blind trial, patients received either diclofenac (50 mg) or placebo twice daily for 14 days.[27]

Previous
Next

Colchicine

The routine use of colchicine in combination with conventional therapy is supported by results from the COlchicine for acute PEricarditis (COPE) trial. In this study, 120 patients with a first episode of acute pericarditis (idiopathic, acute, postpericardiotomy syndrome, or connective tissue disease) entered a randomized, open-label trial comparing aspirin treatment alone with aspirin plus colchicine (1-2 mg for the first day followed by 0.5-1 mg daily for 3 mo).[28]

In the study, colchicine reduced symptoms at 72 hours (11.7% vs 36.7) and reduced recurrence at 18 months (10.7% vs 36.7%). Colchicine was discontinued in 5 patients because of diarrhea, but no other adverse events were noted. Importantly, none of the 120 patients developed cardiac tamponade or progressed to pericardial constriction. The ICAP Trial (Investigation on Colchicine for Acute Pericarditis) will provide further information regarding the use of colchicine as first-line therapy.[29]

However, colchine may not be effective for patients with asymptomatic postoperative pericardial effusion. A study involving 149 patients with mild or moderate pericardial effusion on transthoracic echocardiography found no significant difference on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients who received colchicine (n = 74) and those who received placebo (n = 75).{ref 89} The investigators attributed these findings to the likelihood that most of the cases of pericardial effusion were from noninflammatory causes.

Previous
Next

Steroids

Steroid administration early in the course of acute pericarditis appears to be associated with an increased incidence of relapse after the steroids are tapered. In the COPE trial, steroid use was an independent risk factor for recurrence. Also, an observational study strongly suggested that the use of steroids increases the probability of relapse in patients treated with colchicine.[28]

Systemic steroids should be considered only in patients with recurrent pericarditis that is unresponsive to NSAIDs and colchicine or as needed for treatment of an underlying inflammatory disease. If steroids are to be used, an effective dose (1-1.5 mg/kg of prednisone) should be given, and it should be continued for at least 1 month before slow tapering. The European Society of Cardiology recommends that systemic corticosteroid therapy be restricted to connective-tissue diseases, autoreactive pericarditis, or uremic pericarditis.[26]

The intrapericardial administration of steroids has been reported to be effective in acute pericarditis without producing the frequent reoccurrence of pericarditis that complicates the use of systemic steroids,[30] but the invasive nature of this procedure limits its use.

Previous
Next

Antibiotics

Purulent pericarditis

In patients with purulent pericarditis, urgent pericardial drainage combined with intravenous (IV) antibacterial therapy (eg, vancomycin 1 g bid, ceftriaxone 1-2 g bid, and ciprofloxacin 400 mg daily) is mandatory. Irrigation with urokinase or streptokinase, using large catheters, may liquify the purulent exudate, but open surgical drainage is preferable.

Tuberculous pericarditis

The initial treatment of tuberculous pericarditis should include isoniazid 300 mg daily, rifampin 600 mg daily, pyrazinamide 15-30 mg/kg daily, and ethambutol 15-25 mg/kg daily. Prednisone 1-2 mg/kg daily is given for 5-7 days and progressively reduced to discontinuation in 6-8 weeks. Drug sensitivity testing is essential. Uncertainty remains whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction.

Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction and pericardiectomy in nonresponders after 4-8 weeks of antituberculosis chemotherapy.

Previous
Next

Hemodynamic Support

Patients who have an effusion with actual or threatened tamponade should be considered to have a true or potential emergency. Most patients require pericardiocentesis to treat or prevent tamponade. However, treatment should be carefully individualized.

Hemodynamic monitoring with a balloon flotation pulmonary artery catheter is useful, especially in patients with tamponade or threatened tamponade in whom a decision is made to defer pericardiocentesis. Hemodynamic monitoring is also helpful after pericardiocentesis to assess reaccumulation and the presence of underlying constrictive disease. However, insertion of a pulmonary artery catheter should not be allowed to delay definitive therapy in critically ill patients.

IV fluid resuscitation may be helpful in cases of hemodynamic compromise. In patients with tamponade who are critically ill, IV positive inotropes (dobutamine, dopamine) can be used but are of limited use and should not be allowed to substitute for or delay pericardiocentesis.

Previous
Next

Pericardiocentesis

As previously mentioned, pericardiocentesis is used for diagnostic as well as therapeutic purposes. Pericardial fluid drainage can be performed by percutaneous catheter drainage or open surgical approach. Individual patient characteristics (eg, loculated vs circumferential, recurrent pericardial effusion, need for pericardial biopsy and location of pericardial effusion) and local practice patterns aid in deciding the optimal method of drainage.

Percutaneous pericardial fluid drainage (pericardiocentesis) is the most common method used for pericardial fluid removal. It can be performed under fluoroscopic, echocardiographic, or CT guidance.

Echocardiographic pericardial fluid drainage has established itself as the criterion standard technique. In study of 1127 procedures performed on 977 patients, echocardiographic-guided pericardiocentesis was successful in 97%, with 1.2% major and 3.5% minor complications.[31] It also established the extended drainage as a means to reduce the recurrence rate.

Use of a needle that is at least 5cm long and 16-gauge in diameter and that has a short bevel can minimize the risk of complications and should allow for adequate pericardial drainage. A system allowing placement of a catheter over the needle is preferred.

Contrast echocardiography using agitated saline is useful in cases in which bloody fluid is aspirated, to determine if the needle is in the ventricular cavity.

Attaching an ECG electrode to the pericardiocentesis needle is also useful for avoiding myocardial puncture. Electrical activity will be seen on the monitor when the needle comes into contact with atrial or ventricular myocardium. These changes may be delayed, however, and instill a false sense of security in needle placement. Sense of touch and the findings on aspiration should guide the procedure, with the clinician ultimately relying on good clinical sense.

Complications of pericardiocentesis include ventricular rupture, dysrhythmias, pneumothorax, myocardial and/or coronary artery laceration, and infection. Recurrence rates for pericardial effusion within 90 days may be as high as 90% in patients with cancer.

Previous
Next

Pericardiotomy and Pericardiostomy

Balloon pericardotomy

In this procedure, a catheter is placed in the pericardial space under fluoroscopy. Inflation of the balloon creates a channel for passage of fluid into the pleural space, where reabsorption occurs more readily. Balloon pericardiotomy may be useful for recurrent effusions.

CT-guided pericardiostomy

Patients with effusions after cardiothoracic surgery often have limited echocardiographic windows, as well as loculated effusions, and may be on continued ventilatory support, all of which increase the difficulty of echo-guided pericardiocentesis.

CT pericardial fluid drainage has evolved as an emerging technique suited to overcome this dilemma. It has been shown as an alternative technique in patients in whom fluoroscopically or echocardiographically guided pericardiocentesis is difficult. Echocardiography can be limited due to various patient characteristics (eg, postoperative state, obesity, or chronic obstructive pulmonary disease) or due to a limitation of echocardiography in differentiating pericardial fluid from other possible surrounding structures.

In one large series, CT-directed diagnostic and therapeutic pericardiocentesis was attempted in 261 patients, with 98.4% success, 0.3% major complications and 6.9% minor complications.[32]

In 2010, Eichler et al reported their data on CT-guided pericardiocentesis in 20 patients who were poor candidates for echocardiographic drainage or pericardial fluid was not well visualized by echocardiography. All patients had successful drainage, with 0% mortality and no major complications.[33]

A report by Palmer et al suggested that, in postsurgical cases, CT-guided pericardial drainage is both safe and cost effective. The authors reported on 36 patients—33 of whom underwent major cardiothoracic surgery and 3 of whom were treated with minimally invasive procedures—whose symptomatic pericardial effusions were drained using CT-guided percutaneous placement of an indwelling pericardial catheter.[34]

There were no clinically significant complications associated with any of the placement procedures. Thirty-three patients experienced no symptom recurrence following catheter removal, although pericardial effusion did recur in the remaining 3 patients, requiring a repeat treatment.

Comparing procedure costs, the authors determined that the CT-guided tube pericardiostomies cost 89% less than intraoperative pericardial window procedures would have. No significant procedure-cost differences were found between CT-guided and ultrasonographically guided tube pericardiostomies.

Previous
Next

Subxiphoid Pericardial Window With Pericardiostomy

This procedure is associated with low morbidity, mortality, and recurrence rates, and can be considered as a reasonable alternative diagnostic or treatment modality to pericardiocentesis in selected patients.[35]

The surgery can be performed under local anesthesia. This is advantageous because general anesthesia often leads to decreased sympathetic tone, resulting in hemodynamic collapse in patients with pericardial tamponade and shock. This procedure may be less effective when effusion is loculated.

One study indicated that the procedure may be safer and more effective at reducing recurrence rates than pericardiocentesis. However, only patients who were hemodynamically unstable underwent pericardiocentesis, and no change in overall survival rate was observed.

Previous
Next

Thoracotomy and Median Sternotomy

Thoracotomy

This procedure should be reserved for patients in whom conservative approaches have failed. Thoracotomy allows for creation of a pleuropericardial window, which provides greater visualization of the pericardium. Thoracotomy requires general anesthesia and thus has higher morbidity and mortality rates than does the subxiphoid approach.

Median sternotomy

This procedure is reserved for patients with constrictive pericarditis. The operative mortality rate is high (5-15%).

Previous
Next

Video-Assisted Thoracic Surgery

Video-assisted thoracic surgery (VATS) allows resection of a wider area of the pericardium than the subxiphoid approach does, without the morbidity of thoracotomy.[36] The surgeon is able to create a pleuropericardial window and address concomitant pleural pathology, which is especially common in patients with malignant effusions.

One disadvantage of VATS is that it requires general anesthesia with single lung ventilation, which may be difficult in otherwise seriously ill patients.

Previous
 
 
Contributor Information and Disclosures
Author

William J Strimel, DO, FACP Cardiologist, Lehigh Valley Heart Specialists

William J Strimel, DO, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bilal Ayub, MD Chief Cardiology Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Bilal Ayub, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Echocardiography, National Lipid Association, American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Tahmeed Contractor, MD Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Tahmeed Contractor, MD is a member of the following medical societies: American College of Cardiology, Indian Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Acknowledgements

Ramin Assadi, MD, Senior Fellow, Department of Cardiology, Loma Linda University School of Medicine

Ramin Assadi, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, FHRS Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS 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, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

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; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Justin D Pearlman, MD, PhD, ME, MA Director of Advanced Cardiovascular Imaging, 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.

Ali A Sovari, MD, FACP, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois College of Medicine; Staff Physician and Hospitalist, St John Regional Medical Center, Cogent Healthcare, Inc

Ali A Sovari, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Physiological Society, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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

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

  3. Tsang TS, Barnes ME, Hayes SN, 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. 1999 Aug. 116(2):322-31. [Medline].

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

  5. Rosenbaum E, Krebs E, Cohen M, et al. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus. 2009 Jun. 18(7):608-12. [Medline].

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

  7. Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P. Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS. Pediatr Cardiol. 2009 Nov 14. [Medline].

  8. Lind A, Reinsch N, Neuhaus K, et al. Pericardial effusion of HIV-infected patients ? Results of a prospective multicenter cohort study in the era of antiretroviral therapy. Eur J Med Res. 2011 Nov 10. 16(11):480-3. [Medline]. [Full Text].

  9. Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations. Am J Med Sci. 2009 Sep. 338(3):211-6. [Medline].

  10. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004 Feb 28. 363(9410):717-27. [Medline].

  11. Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation. 2008 Aug 5. 118(6):667-71. [Medline].

  12. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985 Oct 1. 56(10):623-30. [Medline].

  13. Ben-Horin S, Bank I, Shinfeld A, Kachel E, Guetta V, Livneh A. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis. Am J Cardiol. 2007 May 1. 99(9):1294-7. [Medline].

  14. Refaat MM, Katz WE. Neoplastic pericardial effusion. Clin Cardiol. 2011 Oct. 34(10):593-8. [Medline].

  15. Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A, et al. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. 1996 Oct 1. 94(7):1635-41. [Medline].

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

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

  18. Horowitz MS, Schultz CS, Stinson EB. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation. 1974. 50:239-47.

  19. Faehnrich JA, Noone RB Jr, White WD, et al. Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities. J Cardiothorac Vasc Anesth. 2003 Feb. 17(1):45-50. [Medline].

  20. 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. 2001 Jul. 157(1):203-9. [Medline].

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

  22. Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. Radiographics. 2007 Nov-Dec. 27(6):1595-610. [Medline].

  23. Watanabe A, Hara Y, Hamada M, et al. A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening. Magn Reson Imaging. 1998 Apr. 16(3):347-50. [Medline].

  24. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003 Aug 14. 349(7):684-90. [Medline].

  25. Bruch C, Schmermund A, Dagres N, Bartel T, Caspari G, Sack S, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol. 2001 Jul. 38(1):219-26. [Medline].

  26. [Guideline] Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004 Apr. 25(7):587-610. [Medline].

  27. Meurin P, Tabet JY, Thabut G, Cristofini P, Farrokhi T, Fischbach M, et al. Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial. Ann Intern Med. 2010 Feb 2. 152(3):137-43. [Medline].

  28. 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. 2005 Sep 27. 112(13):2012-6. [Medline].

  29. Imazio M, Cecchi E, Ierna S, Trinchero R. Investigation on Colchicine for Acute Pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design amd rationale. J Cardiovasc Med (Hagerstown). 2007 Aug. 8(8):613-7. [Medline].

  30. 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. 2002 Oct. 23(19):1503-8. [Medline].

  31. Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002 May. 77(5):429-36. [Medline].

  32. Klein SV, Afridi H, Agarwal D, Coughlin BF, Schielke LH. CT directed diagnostic and therapeutic pericardiocentesis: 8-year experience at a single institution. Emerg Radiol. 2005 Nov. 11(6):353-63. [Medline].

  33. Eichler K, Zangos S, Thalhammer A, et al. CT-guided pericardiocenteses: clinical profile, practice patterns and clinical outcome. Eur J Radiol. 2010 Jul. 75(1):28-31. [Medline].

  34. Palmer SL, Kelly PD, Schenkel FA, Barr ML. CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion. Am J Roentgenol. OCT 2009. 193:W314-20. [Medline].

  35. Motas C, Motas N, Rus O, Horvat T. Left paraxiphoidian approach for drainage of pericardial effusions. Interact Cardiovasc Thorac Surg. 2010 Jan. 10(1):4-5. [Medline]. [Full Text].

  36. Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc. 2009 Mar. 24(1):44-9. [Medline]. [Full Text].

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

  38. 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. 2005 Apr. 26(7):723-7. [Medline].

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

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

  41. 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. 2000 May. 21(10):832-6. [Medline].

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

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

  44. 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. 1997 Mar 18. 95(6):1686-744. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  63. 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. 2002 Oct. 23(19):1503-8. [Medline].

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

  65. 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. 2007 Jan. 2(1):65-8. [Medline].

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

  67. 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. 1999 Oct. 138(4 Pt 1):759-64. [Medline].

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

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

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

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

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

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

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

  75. Ruiz-García J, Jiménez-Valero S, Moreno R, Galeote G, Sánchez-Recalde A, Calvo L, et al. Percutaneous Balloon Pericardiotomy as the Initial and Definitive Treatment for Malignant Pericardial Effusion. Rev Esp Cardiol. 2012 Dec 21. [Medline].

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

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

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

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

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

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

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

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

  84. 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. 1984 Mar. 69(3):506-11. [Medline].

  85. 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. 1997 May 8. 387(6629):151-8. [Medline].

  86. Fenstad ER, Le RJ, Sinak LJ, et al. Pericardial effusions in pulmonary arterial hypertension: characteristics, prognosis, and role of drainage. Chest. 2013 Nov. 144 (5):1530-8. [Medline].

  87. Celik S, Lestuzzi C, Cervesato E, et al. Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg. 2014 Nov. 148 (5):2288-93. [Medline].

  88. Andreasen JJ, Sorensen GV, Abrahamsen ER, et al. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg. 2016 Jan. 49 (1):288-92. [Medline].

  89. Izadi Amoli A, Bozorgi A, HajHossein et al. Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial. Am Heart J. 2015 Dec. 170 (6):1195-201. [Medline].

 
Previous
Next
 
This 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 patient with a moderate pericardial effusion.
This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).
This electrocardiogram (ECG) is from a patient with malignant pericardial effusion. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.
Subcostal view of an echocardiogram that shows a moderate to large amount of pericardial effusion.
This echocardiogram shows a large amount of pericardial effusion (identified by the white arrows).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.