Pericardial effusion
| Pericardial effusion | |
|---|---|
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| A 2D transthoracic Echocardiogram of pericardial effusion. The Swinging heart | |
| Classification and external resources | |
| Specialty | Cardiac surgery |
| ICD-10 | I30, I31.3 |
| ICD-9-CM | 423.9 |
| DiseasesDB | 2128 |
| eMedicine | med/1786 |
| Patient UK | Pericardial effusion |
| MeSH | D010490 |
Pericardial effusion ("fluid around the heart") is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. A pericardial effusion with enough pressure to adversely affect heart function is called cardiac tamponade. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of pericardial fluid, or from a structural abnormality that allows fluid to enter the pericardial cavity.
Normal levels of pericardial fluid are from 15 to 50 mL.
Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication; signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds.
The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.
It can be associated with dullness to percussion over the left subscapular area due to compression of the left lung base. This phenomenon is known as Ewart's sign.
It may be:
Pericardial effusion etiologies have changed over time and vary greatly depending on geography and the population in question. When pericardial effusion is suspected, echocardiography usually confirms the diagnosis and allows assessment for signs of hemodynamic instability. Cross-sectional imaging with computed tomography (CT) can help to localize and quantify (as in a loculated effusion) or assess for pericardial pathology (pericardial thickening, constrictive pericarditis).
A CT scan image showing a pericardial effusion
A very large hemorrhagic pericardial effusion due to malignancy as seen on ultrasound. closed arrow: the heart, open arrow: the effusion
Pericardial effusion due to malignancy. Note bulbous heart and primary lung cancer in right upper lobe.
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