Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature - PubMed (original) (raw)

Review

Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature

Pouya Ebrahimi et al. J Cardiothorac Surg. 2025.

Abstract

Pericardial effusion is a relatively common complication associated with inflammatory and non-inflammatory diseases. The primary etiology of this condition could be considered when choosing therapeutic options and factors such as effusion size and its hemodynamic consequence. In most cases, small to moderate pericardial effusions can be managed with observation and anti-inflammatory medications unless the effusion develops rapidly. However, in a small proportion of patients, large effusions lead to impaired cardiac filling with hemodynamic compromise and cardiovascular collapse due to cardiac tamponade. The rate at which fluid accumulates is the primary determinant of hemodynamic impact and thus guides the choice of treatment, irrespective of the effusion's size. Severe cases are typically treated with pericardiocentesis with echocardiographic guidance. More aggressive treatments may be necessary for cases due to purulent or malignant etiologies. These cases may require a pericardial window to allow for long-term drainage of the pericardial fluid. This comprehensive review focuses on the epidemiology of pericardial effusion and discusses pathophysiology, diagnostic approaches, and therapeutic options for different causes of secondary pericardial effusions.

Keywords: Cardiac imaging; Cardiovascular disease; Infections; Inflammations; Pericardial effusion; Pericarditis.

© 2025. The Author(s).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1

Fig. 1

Echocardiography can show the amount of fluid around the heart in pericardial effusions

Fig. 2

Fig. 2

Tamponade leads to increased intrapericardial pressure (holodiastolic compression), impairs ventricular filling, and consequently leads to elevated and equal left ventricular end-diastolic pressure (LVEDP) and right ventricular end-diastolic pressure (RVEDP) and reduction in stroke volume and cardiac output

Fig. 3

Fig. 3

Secondary causes of moderate to severe PE based on Levy et al. Study in 2003 (France) [20], Corey et al. study in 1993 (USA) [21], Reuter et al. study in 2005 (South Africa) [22], and Ma W et al. study in 2012 (China) [23]

Fig. 4

Fig. 4

Risk of PE after different cardiovascular events [134]

Fig. 5

Fig. 5

Hemopericardium can be caused by interventional or surgical cardiac procedures and, in severe cases, can lead to hemodynamic deterioration, cardiovascular collapse, and even death

Fig. 6

Fig. 6

Percentage of pericardial effusion among hypothyroid patients

Fig. 7

Fig. 7

General therapeutic approach to traumatic and non-traumatic PE [27]

References

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