Pericardial effusion types
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Abdelrahman Ibrahim Abushouk, MD[2], Cafer Zorkun, M.D., Ph.D. [3], Varun Kumar, M.B.B.S
Overview
Pericardial effusion can be classified according to the nature of pericardial fluid into transudative, exudative, hemorrhagic, and malignant. Further, it can be classified according to the underlying cause into idiopathic, infectious, neoplastic, and post-operative. In addition, Horowitz et al. developed a classification for pericardial effusions based on echocardiographic findings (the degree of separation between the pericardium and epicardium).
Classification
Pericardial effusion can be classified according to the pericardial fluid nature into[1][2]:
- Transudative
- Exudative
- Hemorrhagic
- Malignant
- Metastasis (direct or seeding through pericardiocentesis)
Further, it can be categorized according to the underlying cause into[3][4]:
- Idiopathic
- Infectious (Bacterial, Fungal, HIV, protozoal, parasitic)
- Neoplastic (Direct tumor extension, retrograde lymphatic extension, hematologic metastasis/seeding, and pericardiocentesis seeding)
- Post-operative (early chest tube removal after cardiac surgery).
Horowitz et al. developed a classification for pericardial effusions based on echocardiographic findings.[5] This classification has been endorsed by the European Society of Cardiology[6].
- Type A: No effusion
- Type B: Separation of epicardium and pericardium (3–16 ml ¼ 1–3 mm)
- Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >15 ml P 1 mm in Diastole)
- Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion
- Type D: Pronounced separation of epicardium and pericardium with large echo-free space
- Type E:: Pericardial thickening (>4 mm)
References
- ↑ Refaat MM, Katz WE (2011). "Neoplastic pericardial effusion". Clin Cardiol. 34 (10): 593–8. doi:10.1002/clc.20936. PMC 6652358 Check
|pmc=value (help). PMID 21928406. - ↑ Levy PY, Habib G, Collart F, Lepidi H, Raoult D (2006). "Etiological diagnosis of pericardial effusion". Future Microbiol. 1 (2): 229–39. doi:10.2217/17460913.1.2.229. PMID 17661668.
- ↑ Santas E, Núñez J (2016). "Prognostic implications of pericardial effusion: The importance of underlying etiology". Int J Cardiol. 202: 407. doi:10.1016/j.ijcard.2015.09.051. PMID 26432490.
- ↑ Levy PY, Habib G, Collart F, Lepidi H, Raoult D (2006). "Etiological diagnosis of pericardial effusion". Future Microbiol. 1 (2): 229–39. doi:10.2217/17460913.1.2.229. PMID 17661668.
- ↑ Horowitz MS, Schultz CS, Stinson EB, Harrison DC, Popp RL (1974). "Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion". Circulation. 50 (2): 239–47. doi:10.1161/01.cir.50.2.239. PMID 4846631.
- ↑ Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "[Guidelines on the diagnosis and management of pericardial diseases. Executive summary]". Rev Esp Cardiol. 57 (11): 1090–114. doi:10.1016/s0300-8932(04)77245-0. PMID 15544758.