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Pericardial effusion: Difference between revisions
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'''Pericardial effusion''' refers to accumulation of pathological amounts of fluid in the pericardial cavity. In physiological cases there is 15-50 mL of fluid in the cavity. It may cause [[cardiac tamponade]], which is an emergency. If the fluid is blood it's called haemopericardium. | <section begin="radiology" />'''Pericardial effusion''' refers to accumulation of pathological amounts of fluid in the pericardial cavity. In physiological cases there is 15-50 mL of fluid in the cavity. It may cause [[cardiac tamponade]], which is an emergency. If the fluid is blood it's called haemopericardium. | ||
'''Cardiac tamponade''' is a condition where a pericardial effusion compresses the heart, leading to life-threatening [[acute heart failure]]. This occurs if the pericardial effusion develops rapidly or is large. It’s an emergency which should be treated empirically even before a proper diagnosis is made. | '''Cardiac tamponade''' is a condition where a pericardial effusion compresses the heart, leading to life-threatening [[acute heart failure]]. This occurs if the pericardial effusion develops rapidly or is large. It’s an emergency which should be treated empirically even before a proper diagnosis is made. | ||
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* Metastasis | * Metastasis | ||
* Cardiac wall rupture (trauma, [[Acute myocardial infarction|MI]]) | * Cardiac wall rupture (trauma, [[Acute myocardial infarction|MI]]) | ||
<section end="radiology" /> | |||
== Pathomechanism == | == Pathomechanism == | ||
In cases where the fluid accumulates quickly, only small amounts of fluids (100-150 mL) are required to cause symptoms. Symptoms occur because the pressure in the pericardial cavity increases, preventing diastolic filling of the heart and causing cardiac tamponade. | In cases where the fluid accumulates quickly, only small amounts of fluids (100-150 mL) are required to cause symptoms. Symptoms occur because the pressure in the pericardial cavity increases, preventing diastolic filling of the heart and causing cardiac tamponade. | ||
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* Jugular venous congestion | * Jugular venous congestion | ||
* <abbr>[[Pulsus paradoxus]]</abbr> | * <abbr>[[Pulsus paradoxus]]</abbr> | ||
<section begin="radiology" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
A [[chest x-ray]] may not always show a pericardial effusion. The cardiac shadow may be enlarged. If the effusion is large enough, the heart may appear water bottle-shaped, called "water bottle sign". Echocardiography is the investigation best suited to evaluate pericardial effusion, as it will directly visualise the anechoic fluid around the heart. | A [[chest x-ray]] may not always show a pericardial effusion. The cardiac shadow may be enlarged. If the effusion is large enough, the heart may appear water bottle-shaped, called "water bottle sign". Echocardiography is the investigation best suited to evaluate pericardial effusion, as it will directly visualise the anechoic fluid around the heart. | ||
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** Electrical alternans refers to alternating amplitude (height) of the QRS complex with each heartbeat | ** Electrical alternans refers to alternating amplitude (height) of the QRS complex with each heartbeat | ||
* [[Echocardiography]] – large effusion, collapse of chambers, swinging of the heart | * [[Echocardiography]] – large effusion, collapse of chambers, swinging of the heart | ||
<section end="radiology" /> | |||
== Treatment == | == Treatment == | ||
In case of small pericardial effusions, one can watchfully wait for it to either progress or regress. In case of larger effusions, pericardiocentesis is necessary, under [[ultrasound]] or [[Fluoroscopy|fluoroscopic]] guidance. | In case of small pericardial effusions, one can watchfully wait for it to either progress or regress. In case of larger effusions, pericardiocentesis is necessary, under [[ultrasound]] or [[Fluoroscopy|fluoroscopic]] guidance. | ||
Treatment for cardiac tamponade should not be delayed due to diagnostic evaluations. Treatment is by pericardiocentesis. If unsuccessful, surgery may be necessary. | Treatment for cardiac tamponade should not be delayed due to diagnostic evaluations. Treatment is by pericardiocentesis. If unsuccessful, surgery may be necessary. | ||
[[Category:Cardiology]] | <noinclude>[[Category:Cardiology]] | ||
[[Category:Internal Medicine (POTE course)]] | [[Category:Internal Medicine (POTE course)]]</noinclude> | ||