Complications
Accumulation of transudate, exudate, or blood in the pericardial sac can occur due to pericardial inflammation. Increased intrapericardial pressure from the pericardial effusion (particularly one in which the fluid accumulation occurs over a relatively short time) can compress the cardiac chambers leading to cardiac tamponade.[1][14][48]
Pericardiocentesis is indicated for hemodynamic compromise, purulent pericarditis, and a high suspicion of tumor. The effusion should be drained dry and the fluid analyzed for glucose, protein, and lactic dehydrogenase. Cell count, microscopy, bacterial and/or viral culture, and cytologic exam should be performed.
In some situations, pericardiocentesis cannot be performed from a percutaneous approach and surgical drainage is required. A subxiphoid approach is generally successful and has <1% complication rate and 8% rate of recurrence of effusion.
Pericardial biopsy should be considered if malignant or granulomatous disease is suspected.
Most cases occur within 3 to 12 months after the pericardial insult. It is a relatively rare complication.[76] In developed countries, it is most frequently caused by prior cardiac surgery (prevalence of 0.2% to 0.3%), radiation therapy (4% of patients with radiation for mediastinal Hodgkin), and idiopathic pericarditis. Tuberculosis is the main cause in developing countries.
In the healing process of acute, fibrinous, serofibrinous, or chronic pericardial effusion, the pericardial cavity can be completely replaced by granulation tissue. This results in a dense scar that encases the heart and interferes with ventricular filling. Surgical pericardial resection is the definitive treatment.[1][2][13][14][77]
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