Many kinds of conditions can affect the pericardium. These include acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. Sometimes, they may progress to recurrent pericarditis. Pericardial cysts or even an absent pericardium are congenital defects. 

Acute pericarditis is inflammation of the pericardium, either occurring on its own or as part of a more significant systemic disease. Constrictive pericarditis occurs when the pericardium becomes thickened and scarred. This may occur due to surgery, tuberculosis, or lung radiation therapy. You can read more about pericarditis here. 

How is pericardial effusion diagnosed?

Some cases of minor amounts of effusion are detected without intention, along with other medical tests. Your doctor will first do a physical examination and ask you questions about how your symptoms started and your history. 

Diagnostic tests will follow this. If your symptoms mimic other severe conditions like myocardial infarction or a heart attack, your doctor may suggest tests to rule them out. The main difficulties that help confirm a diagnosis of pericardial effusion are:

• Echocardiogram - This technique uses sound waves to show the heart in motion. It can roughly determine the amount of fluid in the pericardium. It can also provide insights into how heart function is affected by showing how the movement of chambers is involved in each cardiac cycle. Read more
• ECG - A electrical study of the heart through electrodes placed on your chest. This can help you rule out a heart attack and to confirm cardiac tamponade. Read more
• Chest X-Ray - Chest x-Ray is not as clear a picture but is helpful in acute situations. It helps to visualise the heart and notice more significant effusions. Read more
• CT & MRI - These are highly sensitive evaluations and can detect pericardial effusion and its causes and better understand the pericardium itself.

Your doctor may also ask for lab tests like:

• Complete blood count
• Tests to identify causative agents like immune system tests or tests for infection
• Troponin
• TSH
• B-type Natriuretic peptide

What is the value of CT or MRI imaging in pericardial effusion?

Traditionally, the approach has been keeping echocardiography as the primary diagnostic axis. However, echocardiography can not clearly distinguish the structural components of the pericardium and the amount of fluid it contains. They can also measure the thickness of the pericardial layer. 

CT and MRI are especially useful in evaluating hemorrhagic or loculated effusions, thickening of the pericardium, masses, and congenital anomalies. Ct and MRI also provide a larger field of view, allowing us to image associated abnormalities in the chest. In addition, CT and MRI allow for better chances of identifying the root cause of pericardial effusions that may not be apparent on echocardiograms. 

How is pericardial effusion treated?

Pericardial effusion is usually treatable. But, the root cause may or may not be curable. Your doctor will suggest the best course of treatment based on the particular context. They will decide based on the amount of fluid buildup, the root cause, and the presence of cardiac tamponade. 

Medications are the first line of treatment in smaller effusions that do not pose a threat. Your doctor may suggest anti-inflammatory medication like NSAIDs, steroids, or aspirin based on the condition. Your doctor may also give your cancer or heart failure treatments if they were the cause of the effusion.

Your doctor may suggest surgical treatment to drain the effusion or prevent fluid from building up again. This is immediately indicated if the doctor sees the risk of cardiac tamponade. Some of the procedures are:

• Needle aspiration or pericardiocentesis - Your doctor will numb your skin and use a needle, guided through echocardiography or fluoroscopy. They will then pull out the excess fluid, and in some cases, they may leave a thin tube-like device to keep the pericardium drained for a few days if high fluid levels are expected. 
• Open heart surgery - In some conditions, surgery may be preferred. This is common for slow buildup situations. Video-assisted thoracic surgery options help to create a window in the pericardium that can drain the fluid inside your chest or stomach cavity as it builds up. Read more
• In recurring cases, the surgeon may suggest removing all or part of the pericardium through a process called pericardiectomy. This may also be indicated in constrictive pericarditis.