Diagnostic Considerations

Failure to diagnose and appropriately react to the presence of a pericardial effusion is a potential medicolegal pitfall. In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Drug-induced pericardial disease (eg, from hydralazine, isoniazid, or procainamide)
Chronic graft-versus-host disease (cGVHD)
Constrictive pericarditis
Purulent pericarditis
Radiation pericarditis
Tuberculous pericarditis
Uremic pericarditis
Posttransplant B-cell lymphoproliferative disorder (PTLD)
Doxorubicin- and daunorubicin-related pericarditis or myocardial dysfunction
Cystic lymphangioma
Effusion possibly related to pre–bone-marrow transplant drug conditioning
Malignant hepatic involvement with portal hypertension
Microvascular tumor spread in lungs with secondary pulmonary hypertension
Pericardial celomic cyst (unilocular)
Pericardial teratoma
Superior venacaval obstruction of any cause
Chylous or lymphatic pericardial effusions, whether (1) from congenital thoracic cystic hygroma with pericardial involvement, (2) occurring after surgery for congenital heart disease complicated by elevated venous pressures or trauma to the thoracic duct, or (3) developing secondary to obstruction of lymphatic drainage by mediastinal masses

Differential Diagnoses

Workup

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Media Gallery

Plain chest radiograph from 3-month-old infant with pneumonia and malignant pericardial effusion, showing cardiomegaly and bilateral pneumonic patches.
Two-dimensional echocardiograph from subcostal window, showing large pericardial effusion.
M-mode echocardiograph from child with pericardial effusion.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. Low-power view showing numerous mononuclear cells along with large atypical malignant cells.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. Cytoplasm is reduced to thin rim.