The Common Vein Copyright 2008

Ashley Davidoff MD

 

Introduction

Unusual shape of the cardiac shadow characterised by a narrow nediastinum and a broad base caused by accumulation of fluid in the pericardial space

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 Pericardial effusion

 

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CAUSES

Infectious – viral,  tuberculosis, HIV related Idiopathic

Virus  – echovirus, influenza virus, and coxsackievirus group B.

Bacteria  streptococci, staphylococci, and gram-negative bacilli. Haemophilus influenzae is a common cause in children

Inflammation

rheumatoid arthritis,

SLE

systemic sclerosis,

vasculitides

radiation

Neoplastic –

Malignant  (20% of patients with malignancy have nmetastases to pericardium),

nonmalignant.

Not all cancer-associated effusions are malignant. Mediastinal lymphoma, Hodgkin disease, and metastatic breast cancer have been found to cause transient effusions, likely due to impaired lymphatic drainage, which do not cause long-term sequelae.

Metabolic
Myxedema

Uremia

Drugs

    • Warfarin, heparin
    • Penicillin
    • Phenytoin
    • Procainamide
    • Hydralazine, minoxidil
    • Cromolyn sodium
    • Methysergide
    • Doxorubicin

Mechanical

Postpericardiotomy syndrome

Trauma

penetrating or blunt

Circulatory –

Congestive heart failure, valvular disease

  • Chylopericardium

Idiopathic

PEARLS

Normal amount of fluid – 10-50ccs

The rapid accumulationamount of only 80ccs can lead to tamponade wheras a volume of up to 2 litres if slowly accumulated can be tolerated.

Malignant effusions

Up to 20 percent of autopsy series – lung breast and leukemias lymphomas

Infections   HIV -40-80 PERCENT with or without AIDS –

Mycobacterium avium, M. tuberculosis, Nocardia, fungal infection, viral disease, lymphoma, or Kaposi’s sarcoma.

MI and pericardial effusions

early consequence of acute MI (10 to 15% of cases).

late post-MI syndrome (Dressler’s syndrome) 10 days to 2 mo post-MI (1 to 3%) -fever, pericarditis friction rub, pericardial effusion, pleurisy, pleural effusions, and joint pain.

rupture post-MI, causing hemopericardium. This usually occurs 1 to 10 days post-MI and is more common in women.

TB may not have pulmonary involvement