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Pediatric Malignant Pericardial Effusion Differential Diagnoses

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: Stuart Berger, MD  more...
 
Updated: Feb 04, 2014
 
 

Diagnostic Considerations

Failure to diagnose and appropriately react to the presence of a pericardial effusion is a potential medicolegal pitfall. In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Drug-induced pericardial disease (eg, from hydralazine, isoniazid, or procainamide)
  • Purulent pericarditis
  • Radiation pericarditis
  • Tuberculous pericarditis
  • Uremic pericarditis
  • Doxorubicin- and daunorubicin-related pericarditis or myocardial dysfunction
  • Cystic lymphangioma
  • Effusion possibly related to pre–bone-marrow transplant drug conditioning
  • Malignant hepatic involvement with portal hypertension
  • Microvascular tumor spread in lungs with secondary pulmonary hypertension
  • Pericardial celomic cyst (unilocular)
  • Pericardial teratoma
  • Superior venacaval obstruction of any cause
  • Chylous or lymphatic pericardial effusions, whether (1) from congenital thoracic cystic hygroma with pericardial involvement, (2) occurring after surgery for congenital heart disease complicated by elevated venous pressures or trauma to the thoracic duct, or (3) developing secondary to obstruction of lymphatic drainage by mediastinal masses

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK

Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: Royal College of Paediatrics and Child Health, Paediatrician with Cardiology Expertise Special Interest Group, British Congenital Cardiac Association

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Acknowledgements

Hugh D Allen, MD Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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Plain chest radiograph from 3-month-old infant with pneumonia and malignant pericardial effusion, showing cardiomegaly and bilateral pneumonic patches.
Two-dimensional echocardiograph from subcostal window, showing large pericardial effusion.
M-mode echocardiograph from child with pericardial effusion.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. Low-power view showing numerous mononuclear cells along with large atypical malignant cells.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. Cytoplasm is reduced to thin rim.
 
 
 
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