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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.
Approach to mild pericardial effusion
In an asymptomatic patient, a pericardial effusion of less than 10 mm on the echocardiogram may be an incidental finding, especially in elderly women, as shown in the Framingham study.1 In these patients, neither invasive studies nor treatment are required. A follow up echocardiogram is probably warranted to see if the echocardiographic findings are unchanged. Further investigation or treatment of these patients is not necessary if the echo findings are stable.
Aetiologic spectrum and prognosis of moderate and large pericardial effusion
A wide variety of conditions may result in pericardial effusion. All types of acute pericarditis (inflammatory, infectious, immunologic or of physical origin) can be associated with pericardial effusion.2 In addition, pericardial effusion of varying degrees can be seen in other conditions such as neoplasia (with or without direct pericardial involvement), myxoedema, renal insufficiency, pregnancy, aortic or cardiac rupture, trauma, chylopericardium, or in the setting of chronic salt and water retention of many causes, including chronic heart …
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