Pericardial effusion

Introduction Pericardial effusion is a common clinical manifestation and is one of the important signs of pericardial disease. Pericardial effusion can be seen in exudative pericarditis and other non-inflammatory pericardial lesions, usually by physical examination and X-ray examination. When the pericardial effusion lasts for more than a few months, it constitutes a chronic pericardial effusion. The patient is more common in women, and the age of onset is more than menopause. Patients often participate in daily work without conscious discomfort. When symptoms appear, it is often characterized by shortness of breath and chest pain. Some patients have symptoms of pericardial occlusion early in the course of the disease, and gradually decrease or even disappear with the progress of the disease.

Cause

Infective pericardial effusion

These include tuberculosis, viruses (Coxsackie, flu, etc.), bacteria (S. aureus, pneumococcus, Gram-negative bacilli, molds, etc.), protozoa (ameba), and the like.

2. Non-infected pericardial effusion

Including tumors (especially lung cancer, breast cancer, lymphoma, mediastinal tumors, etc.), rheumatism (rheumatoid arthritis, systemic lupus erythematosus, scleroderma, etc.), heart damage or large blood vessel rupture, endocrine metabolic diseases (such as Hypothyroidism, uremia, gout, etc.), radiation damage, effusion after myocardial infarction, etc.

an examination

Related inspection

Cardiovascular angiography chest fluoroscopy M-mode echocardiography (ME) Doppler echocardiography two-dimensional echocardiography

X-ray inspection

The heart shadow is generally enlarged to both sides (more than 300 ml of effusion). When the effusion (more than 1000 ml) is large, the heart shadow is in the form of a flask, and the shadow of the superior vena cava is widened, and the heart beats weakly under fluoroscopy. Clear lung fields can be distinguished from heart failure.

2. ECG

Often low voltage, tachycardia, a large amount of fluid accumulation, visible voltage alternating.

3. Echocardiography

M-mode ultrasound has a liquid dark area between the anterior wall of the heart and the posterior wall of the heart, that is, the maximum diastolic dark area between the pericardium and the epicardium (10 mm, the effusion is small, as in It is medium between 10 and 19 mm, and a large amount if it is larger than 20 mm.

4. Pericardial puncture

It can confirm the presence of pericardial effusion and relieve the symptoms of pericardial tamponade. A portion of the effusion is taken for laboratory testing of the relevant cause.

Differential diagnosis

First, tuberculous pericarditis

It usually spreads directly from mediastinal lymph node tuberculosis and pulmonary pleural tuberculosis. The clinical features are slow onset, mild symptoms of toxemia, large amount of exudate, and mostly bloody, with a long course of disease, and eventually develop chronic constrictive pericarditis.

Second, viral, pericarditis

Viral pericarditis has increased in recent years, and some people even claim that "viral pericarditis is the first in pericarditis." Most of the following characteristics are used as diagnostic clues:

1 There is a history of viral infection, and pericardial effusion occurs within 1 to 3 weeks after viral infection.

2 can occur simultaneously with viral myocarditis and/or endocarditis.

3 The amount of pericardial effusion is not too much, it can be transient, but it can be re-issued. Generally no obvious tamponade symptoms, effusion can be bloody.

4 light can be asymptomatic, but also can be painful in the anterior region, severe pain in the anterior region of the heart, similar to angina or myocardial infarction.

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