Pericardial effusion differential diagnosis

Pericardial effusion Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pericardial effusion from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Cardiac Catheterization
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Pericardial Window
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Pericardial effusion differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Google Images
American Roentgen Ray Society Images of Pericardial effusion differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pericardial effusion differential diagnosis
CDC on Pericardial effusion differential diagnosis
Pericardial effusion differential diagnosis in the news
Blogs on Pericardial effusion differential diagnosis
Directions to Hospitals Treating Type page name here
Risk calculators and risk factors for Pericardial effusion differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Differential Diagnosis

Serous

• Acute pancreatitis
• Chemotherapeutics
• Chronic disease
• Cirrhosis
• Congestive heart failure
• Dressler's syndrome
• Hypoalbuminemia
• Hypothyroidism
• Infection
• Irradiation
• Malnutrition
• Nephrotic Syndrome

Blood

• Acute myocardial infarction
• Anticoagulants
• Aortic rupture
• Cardiac catheterization
• Chemotherapeutics
• Coagulotherapy
• Heart surgery
• Neoplasm
• Perforation
• Trauma
• Uremia

Lymph or chylous

• Benign obstruction of thoracic duct
• Idiopathic
• Neoplasm

Metastatic tumor

• Breast cancer
• Leukemia
• Lung cancer
• Lymphoma
• Pericarditis

Miscellaneous

• Cardiomyopathy
• Systemic Lupus Erythematosus

Infectious

• Viral
• Pyogenic
• Tuberculous
• Fungal
• Other infections (syphilitic, protozoal, parasitic)
• Pericarditis

Noninfectious

• Idiopathic
• Uremia: Kidney failure with excessive blood levels of urea nitrogen
• Heart surgery
• Neoplasia that has spread to the pericardium
• Acute myocardial infarction: Post myocardial infarction pericarditis (Dressler's syndrome)
• Postirradiation
• Aortic dissection (with leakage into pericardial sac)
• Trauma
• Sarcoidosis
• Pericarditis

Hypersensitivity or autoimmunity related

• Amyloid
• Collagen vascular disease
• Drug-induced
• Lupus
• Pericarditis
• Rheumatic fever

Complete Differential Diagnosis of the Causes of Pericardial Effusion

(By organ system)

Cardiovascular	Post-MI pericarditis in the immediate days following acute MI and Dresslers syndrome which develops later; dissecting aortic aneurysm; endocarditis and underlying myocarditis. Following cardiovascular procedures such as: cathether ablation for arrhythmias, coronary artery bypass grafting (CABG) (postpericardiotomy syndrome), pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium), valvuloplasty.
Chemical / poisoning	Silicosis
Dermatologic	Behcet syndrome
Drug Side Effect	Usually associated with small effusions. Common culprits include hydralazine, procainamide, DOH, isoniazid, phenylbutazone, dantrolene, doxorubicin, methylsergide, penicillin.
Ear Nose Throat	Temporal arteritis
Endocrine	Usually in conjunction with clinically severe hypothyroidism. Most early case reports associated with myxedema and patients also had ascites, pleural effusions and uveal edema. Often resolves with thyroid replacement therapy. A pericardial effusion can be seen as part of an Addisonian crisis.
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	Chylopericardium (from thoracic duct obstruction secondary to tumor, surgical procedure), Cardiopulmonary resuscitation, Postpericardiotomy syndrome, Radiation therapy, Serum sickness
Infectious Disease	Bacterial: Pneumococcus, Streptococcus and Staphylococcus are most common. Also Borrelia,Brucellosis, E.coli, Francisella, Haemophilus influenza, Klebsiella, Legionella(preodominantly by hematogenous spread and approximately 20% by contiguous spread. Usually these patients are quite ill), Meningococci, Neisseria, Proteus, Psuedomonas, Salmonella, Tularemia. Fungal: Actinomycosis, Amebiasis, Aspergillus, Blastomycosis, Candida, Coccidiomycosis,Echinococcus, Histoplasmosis, Nocardia, Toxoplasmosis. Helminthic: Alveolar hydatid disease Protozoal: Entamoeba histolytica Tuberculous: usually bloody, protein greater than 2.5. Initially mostly polymorphonuclear cells, later lymphocytes, monocytes and plasma cells. Usually develops very slowly with significant fibrous reaction. Initially effusive then becomes constrictive. OtherMycoplasma such as mycoplasma pnuemonia can cause pericarditis is well. Viral: Coxsackie B Virus, Echovirus, Adenovirus (less commonly: CMV-especially in HIV patients, EBV, Hepatitis B, Influenza, Mumps, Varicella). Other: , Lyme disease (usually myopericarditis associated with conduction abnormalities). Rickettsia
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Predominantly lung cancer, breast cancer, leukemia, lymphomas (Hodgkins and non-Hodgkins). Less commonly GI malignancies, ovarian cancer, sarcomas and melanomas, metastic, hematogenous, carcinoma, carcinoid, Sipple syndrome, mesothelioma, fibroma, lipoma . Also Kaposis sarcoma in HIV positive patients.
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis
Renal / Electrolyte	Uremic pericarditis is seen in up to 20% of uremic patients requiring chronic hemodialysis. The mechanism is unknown. Most commonly there is a small effusion associated with pain and a pericardial friction rub, but there can be a large effusion and present with tamponade
Rheum / Immune / Allergy	Systemic Lupus Erythematosus or SLE: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate (ESR) , +ANA, +dsDNA, pleural effusions). Occurs in 20-40% of patients with SLE during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically WBC count is less than 10K, and is made up of primarily polymorphonuclear cells (PMNs). Rheumatoid arthritis or RA: Pericarditis can occur without active joint involvement. Also serous or bloody. Usually the protein is > 5 mg/dl, and the glucose is low (<45). The WBC is high at 20-90K. Complement is usually low, and the latex fixation test is usually positive. Other: Amyloidosis, Ankylosing Spondylitis, Behcet syndrome, Familial Mediterranian Fever, Kawasaki disease, Mixed Connective Tissue Disease, Polyarteritis nodosa PAN, Polymyositis,Reiter's Syndrome, acute Rheumatic fever, Sarcoidosis, Scleroderma, Still disease, Systemic sclerosis, Temporal arteritis and , Wegener's.
Sexual	Neisseria gonorrhoeae, Treponema pallidum
Trauma	After blunt or penetrating chest trauma Following cardiovascular procedures such as: cathether ablation for arrhythmias, pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium, valvuloplasty. Following gastrointestinal catastrophes including esophageal rupture, pancreatic-pericardial fistula, esophogeal perforation, gastric perforation.
Urologic	Renal Failure, Uremia
Miscellaneous	Commonly the diagnosis is idiopathic.

References

Template:WikiDoc Sources