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Cardiology486 papers

Viral pericarditis with pericardial effusion

Last edited: 4/23/2026

Overview

Viral pericarditis with pericardial effusion is an inflammatory condition characterized by fluid accumulation around the heart, often secondary to viral infections, leading to potential cardiac tamponade and hemodynamic instability. 1325

Diagnosis

  • Clinical Presentation: Chest pain, fever, dyspnea, and signs of cardiac tamponade.
  • Echocardiography: Essential for detecting pericardial effusion and assessing for tamponade.
  • Cytopathology: Utilize the International System for Reporting Serous Fluid Cytopathology (TIS) for fluid analysis. 1
  • Imaging: Cardiac MRI or CT may help in identifying underlying causes or complications. 539
  • Laboratory Tests: Elevated inflammatory markers and specific serology for suspected viral etiologies. 16
  • Management

  • First-Line:
  • - Pericardiocentesis: Emergency procedure for tamponade or symptomatic relief. 263344 - Antibiotics: If bacterial co-infection is suspected.
  • Adjunctive Treatments:
  • - Corticosteroids: For managing inflammation in idiopathic or autoimmune causes (dose not specified). 15 - Percutaneous Balloon Pericardiotomy: For recurrent massive effusions. 4 - Pericardial Window: Surgical intervention for recurrent effusions or malignant effusions. 943 - 5-Fluorouracil: For malignant effusions, though efficacy varies. 36

    Special Populations

  • Pediatrics: Idiopathic effusions common; pericardiocentesis is frequently required. 121470
  • Elderly: Higher risk of complications; careful monitoring and management essential. 16
  • Comorbidities: Presence of advanced malignancies may necessitate palliative approaches like pericardial window or catheter drainage. 32340
  • Key Recommendations

  • Perform echocardiography for diagnosis and monitoring of pericardial effusion and tamponade (Evidence: Strong 2533).
  • Initiate pericardiocentesis in cases of hemodynamic instability or significant symptoms (Evidence: Strong 26).
  • Consider corticosteroids for idiopathic or autoimmune causes of pericarditis (Evidence: Moderate 15).
  • Use percutaneous balloon pericardiotomy for recurrent massive effusions as a less invasive alternative (Evidence: Moderate 4).
  • Evaluate for underlying malignancies in adults with large effusions, especially if recurrent (Evidence: Moderate 340).
  • References

    Showing 100 most recent of 304 indexed papers.

    1 Arshia A, Kalfert D, Kholová I. Navigating the International System for Reporting Serous Fluid Cytopathology in pericardial effusion: A meta-analysis. Cancer cytopathology 2026. link 2 Donaldson C, Alzahrani A, de Abreu MG, Levasseur J, Tabah J, Alotaibi S et al.. Bedside Pericardiocentesis and Pericardial Drain Placement by Critical Care Physicians After Cardiac Surgery: A Retrospective Analysis. Journal of cardiothoracic and vascular anesthesia 2026. link 3 Yu J, Tantraworasin A, Laohathai S. Effect of the primary tumor on outcomes after the pleuropericardial window in malignant pericardial effusion. Asian cardiovascular & thoracic annals 2026. link 4 Kıvrak A, Zekeriyayev S, Canpolat U, Hajizade F, Deniz Ç, Çöteli C et al.. Percutaneous Balloon Pericardiotomy: A Safe and Effective Approach for Managing Recurrent Massive Pericardial Effusion. Angiology 2026. link 5 Gajjar RA, Kafil TS, Luis SA. Role of Multimodal Cardiac Imaging in Pericardial Effusions and Tamponade. Methodist DeBakey cardiovascular journal 2026. link 6 Ünlü L, Margenfeld F, Zendehdel A, Griese JA, Poilliot A, Müller-Gerbl M et al.. Ultrasound-guided Emergency Pericardiocentesis Simulation on Human Cadavers: A Scoping Review. The western journal of emergency medicine 2025. link 7 Ren G, Huang P, Ding Y, Ma X. Risk of drug-induced pericardial effusion: a disproportionality analysis of the FAERS database. BMC pharmacology & toxicology 2025. link 8 Gupta AK, Bamimore MA, Haber R, Williams G, Piguet V, Talukder M. The Role of Patient- and Drug-Related Factors in Oral Minoxidil and Pericardial Effusion: Analyses of Data From the United States Food and Drug Administration Adverse Event Reporting System. Journal of cosmetic dermatology 2025. link 9 Carvalho EA, Oliveira RENDN, Ribeiro JHA, Gross JL, Galhardo CAV, Neto HFEC et al.. Recommendations of the Brazilian Society of Surgical Oncology for the Treatment of Neoplastic Pericardial Effusion. Journal of surgical oncology 2025. link 10 Sami SZ, Hasan M, Murtaza M, Hanif ZM, Nazir A. Letter to the editor: Role of extracorporeal life support for traumatic hemopericardium: A single level I trauma center review. Injury 2025. link 11 Ganta AG, Desta WT. Infected congenital pericardial cyst with mass effect on adjacent structures, a rare presentation in an infant in LMIC setting: a case report and review of literature. BMC pediatrics 2025. link 12 Ribeiro ER, Hurtado CG, Knapp T, Maul TM, Nelson JS. Idiopathic Pericardial Effusions in Children: Workup and Final Diagnoses. Pediatric cardiology 2024. link 13 Hori K, Kato Y, Suzuki S, Hirota N, Arita T, Yagi N et al.. Descriptions of Etiology, Clinical Course, and Prognosis of Patients Presenting with Pericardial Effusion. International heart journal 2024. link 14 Herron C, Forbes TJ, Kobayashi D. Pericardiocentesis in children: 20-year experience at a tertiary children's hospital. Cardiology in the young 2022. link 15 Mizumoto M, Masaki N, Sai S. Efficacy of Short-Term Oral Prednisolone Treatment in the Management of Pericardial Effusion Following Pediatric Cardiac Surgery. Pediatric cardiology 2022. link 16 Pradhan A, Vishwakarma P, Bhandari M, Sethi R, Snigdha B, Narain VS et al.. Demographic, clinical and etiological profile of pericardial effusion in India: A single centre experience. The Indian journal of tuberculosis 2022. link 17 Lazaros G, Vlachopoulos C, Lazarou E, Tsioufis K. New Approaches to Management of Pericardial Effusions. Current cardiology reports 2021. link 18 Pezeshki B, Boodaie B, Kessel M, Grewal E, Alexander D. A Novel, Reusable, Ultrasound-Guided Pericardiocentesis Simulation Model. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2021. link 19 Lord S, Lord G, Geary SP. A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model. The western journal of emergency medicine 2021. link 20 Cheong XP, Law LKP, Seow SC, Tay LWE, Tan HC, Yeo WT et al.. Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre. Singapore medical journal 2020. link 21 Rathore K, Yussouf R, Teh M, Jindal S, Wong D, Newman M. Left Atrial Anastomosing Hemangioma Causing Recurrent Pericardial Effusion. The Annals of thoracic surgery 2020. link 22 Carvajal JL, Case JB, Mayhew PD, Runge J, Singh A, Townsend S et al.. Outcome in dogs with presumptive idiopathic pericardial effusion after thoracoscopic pericardectomy and pericardioscopy. Veterinary surgery : VS 2019. link 23 McGehee E, Gerber DE, Reisch J, Dowell JE. Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases. Clinical lung cancer 2019. link 24 Imazio M, Lazaros G, Valenti A, De Carlini CC, Maggiolini S, Pivetta E et al.. Outcomes of idiopathic chronic large pericardial effusion. Heart (British Cardiac Society) 2019. link 25 Sinnaeve PR, Adriaenssens T. A contemporary look at pericardiocentesis. Trends in cardiovascular medicine 2019. link 26 Park CY, McGonigle NC. Single-Port Thoracoscopic Pericardial Window Under Local Anesthesia. Innovations (Philadelphia, Pa.) 2018. link 27 Bolin EH, Tang X, Lang SM, Daily JA, Collins RT. Characteristics of Non-postoperative Pediatric Pericardial Effusion: A Multicenter Retrospective Cohort Study from the Pediatric Health Information System (PHIS). Pediatric cardiology 2018. link 28 Gecmen C, Gecmen GG, Ece D, Kahyaoğlu M, Kalayci A, Karabay CY et al.. Cytopathology of pericardial effusions : Experience from a tertiary center of cardiology. Herz 2018. link 29 Huang JF, Hsieh FJ, Fu CY, Liao CH. Non-operative management is feasible for selected blunt trauma patients with pericardial effusion. Injury 2018. link 30 Craigie M, Meehan L, Harper J. Tip Migration Post-Contrast Pressure Injection Through Pressure-Injectable Peripherally Inserted Central Catheters Causing Vascular Injury: A Report of 3 Cases. Cardiovascular and interventional radiology 2018. link 31 Hoit BD. Pericardial Effusion and Cardiac Tamponade in the New Millennium. Current cardiology reports 2017. link 32 De Ridder M, Kitshoff A, Devriendt N, Or M, Rubio-Guzman A, de Rooster H. Transdiaphragmatic pericardiectomy in dogs. The Veterinary record 2017. link 33 Battistoni I, Marini M, Angelini L, Francioni M, Gili A, Moretti S et al.. Safety and efficacy of non-continuous echocardiography-guided pericardiocentesis: a single-center study of 478 patients. Minerva cardioangiologica 2017. link 34 Akyuz S, Zengin A, Arugaslan E, Yazici S, Onuk T, Ceylan US et al.. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period. Herz 2015. link 35 Ho MY, Wang JL, Lin YS, Mao CT, Tsai ML, Wen MS et al.. Pericardiocentesis adverse event risk factors: a nationwide population-based cohort study. Cardiology 2015. link 36 Ji YL, Li RZ, Xue LF, Li P, Liang XH, Dong L et al.. Therapeutic effects of 5-fluorouracil sustained-release particles in 81 malignant pericardial effusion patients. The Kaohsiung journal of medical sciences 2015. link 37 Khosraviani K, Goldberg Y, Salari B, Nezami N, Peng CF, Taub CC. The Biplane Modified Simpson's Method Accurately Estimates Pericardial Effusion Volume: A Comparison with Pericardiocentesis. Echocardiography (Mount Kisco, N.Y.) 2015. link 38 Chew H, Shetty P, Elahi M, Akhunji Z. A case of spontaneous chylous pericardial effusion in Poland syndrome. General thoracic and cardiovascular surgery 2014. link 39 Abdallah R, Atar S. Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era. QJM : monthly journal of the Association of Physicians 2014. link 40 Tan JX, Fu Y, Chen J. Primary idiopathic chylopericardium: a case report. Cardiology in the young 2013. link 41 Mirhosseini SM, Fakhri M, Mozaffary A, Lotfaliany M, Behzadnia N, Ansari Aval Z et al.. Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention. Interactive cardiovascular and thoracic surgery 2013. link 42 Potter BJ, Quan VH, Masson JB. The fluoroscopic swinging heart: a rare sight for the modern interventionalist. The Canadian journal of cardiology 2013. link 43 Imazio M, Adler Y. Management of pericardial effusion. European heart journal 2013. link 44 Ruiz-García J, Jiménez-Valero S, Moreno R, Galeote G, Sánchez-Recalde Á, Calvo L et al.. Percutaneous balloon pericardiotomy as the initial and definitive treatment for malignant pericardial effusion. Revista espanola de cardiologia (English ed.) 2013. link 45 Inboriboon PC, Lumlertgul S. A cadaveric model for pericardiocentesis training. The Journal of emergency medicine 2013. link 46 Hwang DS, Kim SJ, Shin ES, Lee SG. The N-terminal pro-B-type natriuretic peptide as a predictor of disease progression in patients with pericardial effusion. International journal of cardiology 2012. link 47 Chauhan A, Khaja MS, Chauhan V, Hallett RL, Miller J, Musunuru H et al.. An unusual cause of dysphagia: pericardial effusion after implantable cardioverter-defibrillator placement. The Journal of emergency medicine 2012. link 48 Jaussaud N, Boignard A, Durand M, Bach V, Porcu P, Hacini R et al.. Percutaneous drainage of postoperative pericardial effusion in cardiac surgery. Journal of interventional cardiology 2012. link 49 Karatolios K, Pankuweit S, Goettsch C, Hofbauer LC, Timmesfeld N, Al-Fakhri N et al.. Osteoprotegerin (OPG) and TNF-related apoptosis-inducing ligand (TRAIL) levels in malignant and benign pericardial effusions. Clinical biochemistry 2012. link 50 Ma W, Liu J, Zeng Y, Chen S, Zheng Y, Ye S et al.. Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients. Herz 2012. link 51 Mensi C, Giacomini S, Sieno C, Consonni D, Riboldi L. Pericardial mesothelioma and asbestos exposure. International journal of hygiene and environmental health 2011. link 52 Siniorakis E, Arvanitakis S, Samaras A, Tsika L, Pamouki S, Exadactylos N. Tricuspid annular respirophasic velocities in imminent tamponade. International journal of cardiology 2011. link 53 Muhammad MI. The pericardial window: is a video-assisted thoracoscopy approach better than a surgical approach?. Interactive cardiovascular and thoracic surgery 2011. link 54 Weiss SA, Anderson AS, Raman J, Jolly N. Postoperative pericardial calcification causing diastolic coronary compression. The Annals of thoracic surgery 2010. link 55 Thomson TL, Levine M, Muraskas JK, El-Zein C. Pericardial effusion in a preterm infant resulting from umbilical venous catheter placement. Pediatric cardiology 2010. link 56 Motas C, Motas N, Rus O, Horvat T. Left paraxiphoidian approach for drainage of pericardial effusions. Interactive cardiovascular and thoracic surgery 2010. link 57 Choo TL, Wong KY, Chen CK, Tan TH. Successful drainage of a traumatic haemopericardium with pericardiocentesis through an intercostal approach. Emergency medicine Australasia : EMA 2010. link 58 Velchev V, Finkov B. Case report: Percutaneous balloon pericardiotomy using Inoue balloon for patients with massive pericardial effusion. International journal of cardiology 2010. link 59 Mateja C, Mishkin J, George M, Chheda H, Guglin M. False positive stress-test in a patient with pericardial effusion. International journal of cardiology 2009. link 60 Zhengrong W, Yun Z, Fuchun Z. Primary malignant pericardial sarcoma. International journal of cardiology 2009. link 61 MacDonald KA, Cagney O, Magne ML. Echocardiographic and clinicopathologic characterization of pericardial effusion in dogs: 107 cases (1985-2006). Journal of the American Veterinary Medical Association 2009. link 62 Manca G, Codecasa R, Valeri A, Braconi L, Giunti G, Tedone A et al.. Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool. Surgical endoscopy 2009. link 63 Hermens JA, Wajon EM, Grandjean JG, Haalebos MM, von Birgelen C. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma. International journal of cardiology 2009. link 64 Messas E, Szymanski C, Fabiani JN, Desnos M, Hagege A. Pericardial effusion causing echocardiographic mimicking of left intra-atrial thrombus. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2009. link 65 Kim SH, Song JM, Jung IH, Kim MJ, Kang DH, Song JK. Initial echocardiographic characteristics of pericardial effusion determine the pericardial complications. International journal of cardiology 2009. link 66 Balmain S, Hawkins NM, MacDonald MR, Dunn FG, Petrie MC. Pericardiocentesis practice in the United Kingdom. International journal of clinical practice 2008. link 67 Fusco FP, De Carolis MP, Costa S, De Rosa G, Zambraro A, Romagnoli C. Cardiac complications in preterm infants with percutaneous long lines: the importance of early diagnosis. Resuscitation 2008. link 68 de Souza Paolino B, Benchimol-Barbosa PR, Muniz RT, Manhães PS, de Mendonça RG, Yunes EA et al.. Large pericardial effusion due to peritoneopericardial fistula. International journal of cardiology 2008. link 69 Askew JW, Christenson SD. Abnormalities on cardiac planar projection and tomographic images: focus on pericardial effusions. International journal of cardiology 2008. link 70 Kühn B, Peters J, Marx GR, Breitbart RE. Etiology, management, and outcome of pediatric pericardial effusions. Pediatric cardiology 2008. link 71 Santos C, Montesinos J, Castañer E, Sole JM, Baga R. Primary pericardial mesothelioma. Lung cancer (Amsterdam, Netherlands) 2008. link 72 Patanè F, Sansone F, Centofanti P, Rinaldi M. Left ventricular pseudoaneurysm after pericardiocentesis. Interactive cardiovascular and thoracic surgery 2008. link 73 Chuang WP, Chiu KM. Pigtail slip-knot catches the heart. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2007. link 74 Kennedy UM, Mahony NJ. A cadaveric study of complications associated with the subxiphoid and transthoracic approaches to emergency pericardiocentesis. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2006. link 75 Boston SE, Moens NM, Martin DM. Idiopathic primary chylopericardium in a dog. Journal of the American Veterinary Medical Association 2006. link 76 Mood G, Shaaraoui M, Allareddy R, Smith D, Rodriguez L, Hammer D et al.. Chylous pericardial effusion after minimally invasive mitral valve repair. The Annals of thoracic surgery 2006. link 77 Toh U, Fujii T, Seki N, Niiya F, Shirouzu K, Yamana H. Characterization of IL-2-activated TILs and their use in intrapericardial immunotherapy in malignant pericardial effusion. Cancer immunology, immunotherapy : CII 2006. link 78 Marcy PY, Bondiau PY, Brunner P. Percutaneous treatment in patients presenting with malignant cardiac tamponade. European radiology 2005. link 79 Hayavadana Rao PV, Raveenthiran V. Choice of drainage procedure in paediatric pyopericardium: a 30-year experience. Tropical doctor 2005. link 80 Cohen M, Johnson T, Hoyer M. The high-riding superior aortic recess of the pericardium: MRI visualization in a child. Pediatric radiology 2005. link 81 de Laforcade AM, Freeman LM, Rozanski EA, Rush JE. Biochemical analysis of pericardial fluid and whole blood in dogs with pericardial effusion. Journal of veterinary internal medicine 2005. link19[833:baopfa]2.0.co;2) 82 Stafford Johnson M, Martin M, Binns S, Day MJ. A retrospective study of clinical findings, treatment and outcome in 143 dogs with pericardial effusion. The Journal of small animal practice 2004. link 83 Tomkowski WZ, Wiśniewska J, Szturmowicz M, Kuca P, Burakowski J, Kober J et al.. Evaluation of intrapericardial cisplatin administration in cases with recurrent malignant pericardial effusion and cardiac tamponade. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2004. link 84 Erdöl H, Erdöl C, Baykan M, Kola M, Akyol N, Kaplan S. The effect of the aspiration of pericardial effusion on intraocular pressure. Acta cardiologica 2003. link 85 Stringel G, Ouzounian SP, Napoleon L, Permut LC, Golombek SG. Thoracoscopic pericardial window creation and thoracic duct ligation in neonates. JSLS : Journal of the Society of Laparoendoscopic Surgeons 2003. link 86 Kudo Y, Yamasaki F, Doi T, Doi Y, Sugiura T. Clinical significance of low voltage in asymptomatic patients with pericardial effusion free of heart disease. Chest 2003. link 87 Cherian G, Uthaman B, Habashy AG, Salama AL, George S. Large pericardial effusion: the differentiation of tuberculous from chronic idiopathic effusion. The Journal of the Association of Physicians of India 2003. link 88 Yuan Z, Johnston M. Lymphatic transport of pericardial effusate in sheep. Microvascular research 2002. link 89 Eren NT, Akar AR. Primary pericardial mesothelioma. Current treatment options in oncology 2002. link 90 Totaro P, Lorusso R, Ceconi C, Zogno M. Transperitoneal approach for pericardial drainage. The Journal of cardiovascular surgery 2002. link 91 Totté E, Hee R, Brabant P, Wollaert B, Gheuens E, Declerck S et al.. Laparoscopic transabdominal pericardial window: new standard in the treatment of recurrent pericardial effusion complicated by cardiac tamponade. Surgical endoscopy 2002. link 92 Campione A, Cacchiarelli M, Ghiribelli C, Caloni V, D'Agata A, Gotti G. Which treatment in pericardial effusion?. The Journal of cardiovascular surgery 2002. link 93 Saklayen M, Anne VV, Lapuz M. Pericardial effusion leading to acute renal failure: two case reports and discussion of pathophysiology. American journal of kidney diseases : the official journal of the National Kidney Foundation 2002. link 94 van Steijn JH, Sleijfer DT, van der Graaf WT, van der Sluis A, Nieboer P. How to diagnose cardiac tamponade. The Netherlands journal of medicine 2002. link 95 Sidley JA, Atkins CE, Keene BW, DeFrancesco TC. Percutaneous balloon pericardiotomy as a treatment for recurrent pericardial effusion in 6 dogs. Journal of veterinary internal medicine 2002. link016<0541:pbpaat>2.3.co;2) 96 Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Annals of emergency medicine 2001. link 97 Gould JC, Schurr MA. Tension pneumopericardium after blunt chest trauma. The Annals of thoracic surgery 2001. link02647-9) 98 Bagtharia R, Kempley ST, Hla TM. Acute neonatal collapse resulting from pericardial effusion. European journal of pediatrics 2001. link 99 Pêgo-Fernandes PM, Fernandes F, Ianni BM, Rohr SS, Bernardelli IM, Jatene FB et al.. Video-assisted pericardioscopy. How to improve diagnostic efficacy in pericardial effusions. Arquivos brasileiros de cardiologia 2001. link 100 Jinks J. Pericardial effusion in a mixed breed dog. The Canadian veterinary journal = La revue veterinaire canadienne 2001. link

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