Pericardial effusion

Pericardial effusion is one of the common clinical phenomena, and its etiological diagnosis directly affects the treatment outcome and prognosis of patients. There are many causes of pericardial effusion, and the observed results differ in different periods, ages, and hospitals. Therefore, reports in the literature vary greatly, and misdiagnosis of the etiology frequently occurs. Patients with pericardial effusion have varying degrees of cardiac tamponade symptoms and signs, such as chest tightness, shortness of breath, inability to lie flat, progressive dyspnea, cyanosis, muffled heart sounds, enlarged cardiac dullness, hypotension, decreased pulse pressure, paradoxical pulse, jugular venous distension, hepatomegaly, and edema of both lower extremities, including neoplastic pericardial effusion. In some cases, the initial symptoms are fever, chest tightness, chest pain, cough, and sore throat. Patients may have small, moderate, or large pericardial effusions (mostly due to tumors, hypothyroidism, and systemic lupus erythematosus). Laboratory examination of pericardial effusion may reveal exudative fluid, among which there may be hemorrhagic pericardial effusion. Tumors rank first among hemorrhagic and exudative pericardial effusions. Treatment methods for malignant pericardial effusion or cardiac tamponade include percutaneous pericardiocentesis or catheter drainage, pericardial sclerotherapy, pericardial window drainage, pericardiectomy, open thoracotomy, or video-assisted pericardiotomy. It is emphasized that the choice of surgical approach should follow the principle of individualization. In recent years, many clinicians in China have conducted extensive research on intrapericardial catheter drainage followed by intracavitary therapy for patients with moderate to large malignant pericardial effusion. Currently, there is no unified international standard for evaluating the efficacy of treatment for metastatic malignant pericardial effusion.