Pericardial effusion differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mugilan Poongkunran M.B.B.S [2]; Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S

Overview

Most pericardial effusions are caused by inflammation of the pericardium, a condition called pericarditis. As the pericardium becomes inflamed, extra fluid is produced, leading to a pericardial effusion. Viral infections are one of the main causes of pericarditis and pericardial effusions. Infections causing pericardial effusions include cytomegalovirus, coxsackie virus, echovirus, and HIV. However, other conditions like injury to the pericardium or heart from a medical procedure, myocardial infarction, uremia, autoimmune disease and cancer should be considered in differential diagnosis of pericardial effusion.

Differentiating Pericardial Effusion from other Diseases

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication and the signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds. There are several other cardiac insults with similar symptoms that should be considered in differential diagnosis of pericardial effusion.

Differential Diagnosis by Organ System

Cardiovascular Cathether ablation for arrhythmias, coronary artery bypass grafting, dissecting aortic aneurysm, Dresslers syndrome, endocarditis, myocarditis, pacemaker insertion, percutaneous coronary intervention, postpericardiotomy syndrome, TAVI, thoracic surgery, valvuloplasty
Chemical / poisoning Silicosis
Dermatologic Behcet syndrome[1]
Drug Side Effect Dantrolene, doxorubicin, hydralazine, isoniazid, penicillin, phenylbutazone, procainamide
Ear Nose Throat Temporal arteritis[2]
Endocrine Addisonian crisis, Severe hypothyroidism (myxedema)
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease, Whipple's
Genetic Gaucher disease, Jacobs arthropathy-camptodactyly syndrome, Mulibrey nanism syndrome, recurrent hereditary polyserositis
Hematologic Leukemia, lymphoma
Iatrogenic Cardiopulmonary resuscitation, postpericardiotomy syndrome, radiation therapy, serum sickness, thoracic duct obstruction secondary to tumor, surgery
Infectious Disease Actinomycosis, adenovirus, alveolar hydatid disease, amebiasis, aspergillus, blastomycosis, borrelia, brucellosis, candida, coccidiomycosis, coxsackie B virus, cytomegalovirus, Ebstein-Barr virus, echinococcus, echovirus, entamoeba histolytica, escherichia coli, francisella, haemophilus influenza, hepatitis B, histoplasmosis, influenza, klebsiella, legionella, Lyme disease, meningococci, mumps, mycoplasma pnuemonia, neisseria, nocardia, pneumococcus, proteus, pseudomonas, rickettsia, salmonella, staphylococcus, streptococcus, toxoplasmosis, tuberculous, tularemia, varicella
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Breast cancer, carcinoid, fibroma, kaposis sarcoma, leukemia, lipoma, lung cancer, lymphomas, melanoma, mesothelioma, ovarian cancer, sarcoma, Sipple syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal / Electrolyte Uremia
Rheum / Immune / Allergy Acute rheumatic fever, amyloidosis, ankylosing spondylitis, Behcet syndrome, Kawasaki disease, mixed connective tissue disease, polyarteritis nodosa, polymyositis, Reiter's Syndrome, rheumatoid arthritis, sarcoidosis, scleroderma, Still's disease, systemic lupus erythematosus, systemic sclerosis, temporal arteritis, Wegener's
Sexual Neisseria gonorrhoeae[3], treponema pallidum
Trauma Blunt or penetrating chest trauma, esophageal rupture, esophogeal perforation, gastric perforation, pancreatic-pericardial fistula
Urologic Renal Failure, uremia
Miscellaneous Idiopathic

References

  1. Scarlett JA, Kistner ML, Yang LC (1979). "Behçet's syndrome. Report of a case associated with pericardial effusion and cryoglobulinemia treated with indomethacin". Am J Med. 66 (1): 146–8. PMID 420242.
  2. Garewal HS, Uhlmann RF, Bennett RM (1981). "Pericardial effusion in association with giant cell arteritis". West J Med. 134 (1): 71–2. PMC 1272467. PMID 7210667.
  3. Wilson J, Zaman AG, Simmons AV (1990). "Gonococcal arthritis complicated by acute pericarditis and pericardial effusion". Br Heart J. 63 (2): 134–5. PMC 1024342. PMID 2317408.

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