Pericardial effusion is a common finding in everyday practice. Sometimes, its cause is obviously related to an underlying general or cardiac disease, or to a syndrome of inflammatory or infectious acute pericarditis. On other occasions, pericardial effusion is an unexpected finding that requires specific evaluation. In these cases, the main issues are aetiology, the clinical course, and the possibility of evolution to haemodynamic embarrassment. This is especially relevant in cases of large pericardial effusions, in which echocardiographic recordings not infrequently show findings suggestive of subclinical haemodynamic derangement, mainly right atrial or right ventricular wall collapse. These uncertainties have led to a heterogeneous approach to the management of the syndrome of pericardial effusion by different groups of investigators.

The main goal of this article is to give a comprehensive review of aetiology, haemodynamic findings, and management of pericardial effusion. In addition, some comments on the management of neoplastic pericardial effusion are also provided.