Pericardial Effusion, Tamponade, and Constrictive Pericarditis

The normal pericardium is a bilayer fibroelastic sac: the outer fibrous and the inner serous pericardium. The latter is itself divided into two components; a visceral layer adjacent to the epicardium and a more external parietal layer. When excessive fluid accumulates in this pericardial space or when the pericardium becomes thickened and stiffened, one of three pericardial compressive syndromes may occur; cardiac tamponade, constrictive pericarditis and effusive-constrictive pericarditis. Pericarditis may be the first clinical manifestation of a non-diagnosed cancer. Twelve percent of patients with no known malignancy presenting with acute pericarditis with or without pericardial effusion will subsequently be diagnosed with cancer within 5 years. Pericardial syndrome in the oncology patients may be secondary to cancer, malignancy complications, or to side-effects of cancer-therapy, however, they often remain idiopathic. Echocardiography, a portable, low-cost, and non-irradiating technique is often performed as first line. Other modalities such as computer tomography (CT) and cardiac magnetic resonance imaging (CMR) may also be used in the diagnosis and evaluation of pericardial syndrome.