01. Overview of Pericardial Effusion
What Is Pericardial Effusion?
Pericardial effusion occurs when excess fluid accumulates between the layers of tissue around the heart. The layers of tissue form a sac called the pericardium. Pericardial effusion may put pressure on the heart. This can cause additional symptoms and cardiovascular complications.
The pericardium has three layers:
- The fibrous pericardium (outermost layer)
- The parietal pericardium (a second layer)
- The visceral pericardium (innermost layer)
The space between the two inner layers normally contains a small amount of fluid. When the pericardium becomes irritated or injured, the inflammation may lead to a buildup of excess pericardial fluid.
02. Causes of Pericardial Effusion
What Causes Pericardial Effusion?
Pericardial effusion may be caused by a number of conditions, including pericardial mesothelioma. Other potential causes include chest trauma, autoimmune disorders and infection. Pericardial effusion often occurs because of pericardial inflammation (pericarditis) associated with these causes.
Causes of Pericardial Effusion
- Autoimmune conditions including lupus and rheumatoid arthritis
- Bleeding into the pericardial cavity
- Chemotherapy drugs, including doxorubicin and cyclophosphamide
- Chest trauma
- Complications of open-heart surgery
- Infection (bacterial, fungal or viral)
- Kidney failure
- Low thyroid function (hypothyroidism)
- Metastasis of any type of mesothelioma
- Metastasis of cancer
- Radiation therapy
In some cases, doctors cannot determine the cause of pericardial effusion. This is called idiopathic pericarditis. Even if doctors cannot determine the cause of the pericardial effusion, they can still provide patients with a treatment plan.
03. Mesothelioma and Pericardial Effusion
The Connection Between Pericardial Effusion and Mesothelioma
Pericardial effusion is a common symptom of malignant pericardial mesothelioma. Pericardial mesothelioma develops in the lining of the heart after asbestos exposure. It is a rare form of the disease and makes up 1% – 2% of all mesothelioma cases.
As a result of asbestos exposure, fibers may embed in the pericardium and cause inflammation. Over time, pericardial tumors may form. Tumor growth causes the layers of tissue in the pericardium to become irritated. Irritation and inflammation may lead to fluid buildup.
Metastasis of any type of mesothelioma may also cause pericardial effusion. This occurs when mesothelioma spreads to the pericardium from another part of the body.
In some cases, patients may be diagnosed with pericardial effusion before they are diagnosed with mesothelioma.
Due to limited data, it is unclear if early diagnosis of pericardial effusion benefits mesothelioma life expectancy. However, individuals with a history of asbestos exposure can monitor for related symptoms. Early diagnosis may provide pericardial mesothelioma patients access to a wider array of treatment options.
04. Symptoms of Pericardial Effusion
What Are the Signs & Symptoms of Pericardial Effusion?
Some patients may not present with any symptoms of pericardial effusion. In these instances, the excess fluid may build up slowly over time. For other patients, pericardial effusion may cause a variety of symptoms, including chest pain, shortness of breath and swelling of the abdomen and legs.
Pericardial effusion symptoms may vary based on the underlying cause of effusion.
Symptoms of Pericardial Effusion
- Chest pain
- Difficulty swallowing
- Dyspnea (shortness of breath)
- Enlargement of the neck veins
- Feeling of fullness in the abdomen or chest
- Increased heart rate and/or breathing rate
- Orthopnea (inability to breathe easily unless sitting up or standing)
- Swelling of the legs or abdomen
Patients with severe pericardial effusions may experience other symptoms. Cardiac tamponade is one of the most serious complications of pericardial effusion. It occurs when fluid causes severe compression of the heart muscle.
This complication results in poor blood flow and a lack of oxygen to the body. Patients may experience blue lips and skin, shock and changes in mental status as a result. Cardiac tamponade is a medical emergency. It can lead to heart failure and requires urgent treatment.
05. Diagnosis of Pericardial Effusion
Diagnosing Pericardial Effusion
To diagnose pericardial effusion, doctors perform a physical exam and listen to a patient’s heart. If a patient exhibits any pericardial effusion symptoms, doctors can perform additional tests, such as chest X-rays and electrocardiograms.
If a patient is experiencing little to no symptoms, pericardial effusion may be diagnosed accidentally. Doctors report accidental diagnoses when a patient is undergoing tests for other reasons.
Physicians typically diagnose pericardial effusion using one or more of the following tests:
- Chest X-ray: A chest X-ray may show excess fluid in the pericardium and enlargement of the heart.
- CT scan: A CT scan can detect pericardial effusions. However, these are not commonly used to diagnose the condition.
- Echocardiogram: An echocardiogram allows doctors to see how much fluid has collected in the space between the pericardial layers.
- Electrocardiogram: An electrocardiogram, also called an ECG or EKG, records electrical signals from the heart. Doctors may use an EKG to look for patterns that suggest cardiac tamponade.
- MRI: Magnetic resonance imaging (MRI) creates a moving image of the heart. An MRI may be used to evaluate the functioning of the heart and pericardium.
If pericardial effusion is diagnosed, doctors may perform additional testing to determine the cause of the effusion. Additional diagnostic tests may include a fluid biopsy or a blood test. For patients whose pericardial effusion is caused by mesothelioma, doctors will need to take a pericardial biopsy to definitively diagnose the cancer.
06. Treatments for Pericardial Effusion
Common Pericardial Effusion Treatments
There are treatments available for individuals diagnosed with pericardial effusion. Peritoneal mesothelioma patients with effusions may undergo surgery to relieve pressure around the heart and potentially prolong survival. Two common treatments are pericardiocentesis and pericardiectomy.
The type of treatment a patient receives may depend on:
- The amount of fluid in the pericardial sac
- The underlying cause of effusion
- The likelihood of developing cardiac tamponade
In some mild cases, treatment is not necessary. Doctors may continue to monitor patients with repeated echocardiograms.
Pericardiocentesis Drains Excess Fluid
Pericardiocentesis is a minimally invasive procedure that removes the excess fluid from the pericardium. The procedure involves using a needle and a small catheter to access the pericardial cavity and drain the fluid.
A pericardiocentesis may also be performed as part of a more invasive surgery.
Case Study: Pericardiocentesis to Treat Pericardial Effusion Caused by Mesothelioma
- Patient: 71-year-old woman
- Symptoms: Dizziness, difficulty breathing and weight loss
- Diagnosis: She was first diagnosed with pericardial effusion and later with cardiac tamponade. After more testing, the patient was diagnosed with pericardial mesothelioma.
- Treatment: Doctors initially treated the patient with an emergency pericardiocentesis. She later underwent seven cycles of palliative chemotherapy (pemetrexed and cisplatin) to treat her mesothelioma.
- Outcome: According to the last follow-up in the 2017 case report, the patient survived at least 20 months after diagnosis.
Some patients who undergo a pericardiocentesis may experience a recurrence of pericardial effusion. Patients with frequent pericardial effusions may be eligible for a pericardiectomy to help prevent fluid buildup.
Pericardiectomy May Prevent Pericardial Effusion Recurrence
A pericardiectomy is a surgical removal of all, or part of, the pericardium. This procedure is also known as pericardial stripping. The two types of pericardiectomy are:
- A partial pericardiectomy, which removes a diseased portion of the heart lining
- A total pericardiectomy, which removes nearly all of the lining
A pericardiectomy should not cause further complications as long as the patient’s lungs and diaphragm are intact.
Removal of the pericardium has helped patients with severe or repeated cases of pericardial effusion. The procedure can prevent pericardial effusion from occurring in the future.
Treating the Underlying Cause of Pericardial Effusion
Doctors may also treat the underlying cause of pericardial effusion to alleviate symptoms. For instance, pericardial mesothelioma patients may undergo cancer treatment to minimize symptoms of pericardial effusion.
If a patient has another form of metastasized mesothelioma, they may also continue their cancer treatment plan to alleviate pericardial effusion. A mesothelioma doctor can recommend a unique treatment plan for a patient’s diagnosis.
Through early detection and treatment of pericardial effusions, and the underlying cause, patients may improve quality of life.
07. Common Questions
Common Questions About Pericardial Effusion
Can mesothelioma cause pericardial effusion?
- Any type of mesothelioma can result in pericardial effusion. Pericardial mesothelioma may cause effusion, but metastasis of testicular, peritoneal and pleural mesothelioma may also cause it. Pericardial effusion can also result from other cancers such as breast and lung cancer.
What are the common treatments for pericardial effusion?
- Common treatments for pericardial effusions caused by mesothelioma include surgical options such as pericardiocentesis and pericardiectomy. Pericardiocentesis drains excess fluid around the heart. Pericardiectomy removes all or part of the pericardium.