A pericardial effusion is an abnormal amount of fluid between the heart and the pericardium, which is the sac surrounding the heart. Most pericardial effusions are not harmful, but large pericardial effusions can cause problems by impairing heart function. Most pericardial effusions are caused by inflammation of the pericardium. As the pericardium becomes inflamed, extra fluid is produced, leading to a pericardial effusion.
Few large studies have characterized the epidemiology of pericardial effusion. Pericardial effusion has been found in 3.4% of subjects in general autopsy studies. Small pericardial effusions often are asymptomatic. A higher incidence of pericardial effusion is associated with certain diseases. Twenty-one percent of cancer patients have metastases to the pericardium. The most common are lung (37% of malignant effusions), breast (22%), and leukemia/lymphoma (17%). Patients with HIV, with or without AIDS, are found to have increased prevalence, with 41-87% having asymptomatic effusion and 13% having moderate-to-severe effusion. The extrapolated prevalence was found to be 204,209 in Netherlands and the population esteemed used is double of 6,211,215.
Many pericardial effusions do not require any therapy, however if there is concern for cardiac tamponade, pericardiocentesis can be performed percutaneously. This is done via a subxiphoid approach using a needle to drain the fluid under echocardiographic and/or fluoroscopic guidance. This is done for both therapeutic and for diagnostic purposes. A surgical approach using a “pericardial window” is performed when there is concern that the pericardial fluid will accumulate, such as occurs with a malignant pericardial effusion.
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