Pericardial effusion signs

Introduction Pericardial effusion is a more common clinical manifestation, especially after echocardiography becomes a routine examination of cardiovascular disease, the detection rate of pericardial effusion in patients is significantly increased, up to 8.4%, most of the pericardial volume The fluid does not appear clinically due to the small amount. A small number of patients have a prominent clinical manifestation with pericardial effusion due to a large amount of fluid. When the pericardial effusion lasts for more than a few months, it constitutes a chronic pericardial effusion. There are many causes of chronic pericardial effusion, most of which are related to diseases that can affect the pericardium. The apex beat is weak or inaccessible. If it can be touched, it is inside the left border of the heart sound. The heart is enlarged to the sides, and the dullness of the heart is widened in the lying position, and the heart sound is low and distant. When a large amount of fluid is accumulated, voiced and bronchial breath sounds may appear in the area under the left scapula, called the Ewart sign.

Cause

(1) Infectivity

1, bacteria: tuberculosis, pneumonia, streptococcus, meningococcus, gonococcus.

2, virus: 1Coxsackie B, A, Echo virus, influenza virus; 2 infectious mononucleosis.

3, fungi: histoplasma, actinomycetes, cocci, aspergillus, cysticercosis.

4, parasites: amoeba, filarial, hydatid.

5. Rickettsia.

(two) systemic diseases

1, connective tissue disease: systemic lupus erythematosus, scleroderma, rheumatic fever, nodular polyarteritis, rheumatoid arthritis, Takeyasu syndrome, Wegener granulomatosis, dermatomyositis, Behcet's disease.

2, allergic reactions: serum disease, Dresler syndrome, pericardial incision syndrome, post-heart injury syndrome, radiation damage.

3, metabolic diseases: uremia, gout, Addison crisis, new fluid edema, cholesterol pericarditis, spastic pericarditis.

4, adjacent organ lesions involved: acute myocardial infarction, pleurisy, wall aneurysm, pulmonary embolism, esophageal disease.

5, other

Acute pancreatitis, thalassemia, BoanWight syndrome, Wipple syndrome, non-lymphalarthritis, Relier syndrome, nephrotic syndrome, amyloidosis, familial pericarditis.

(three) tumor

1, primary: mesothelioma, sarcoma.

2, secondary: lung cancer, bronchial carcinoma, adenocarcinoma, thymic cancer, melanoma, lymphoma, leukemia.

(four) drug induced

Procainamide, sputum, penicillin, isoniazid, phenylbutazone, methylthioxos, cyclophosphamide, anticoagulant.

(5) Trauma

Pervasive chest trauma, post-thoracic surgery, cardiac catheterization or pacemaker implantation, cardiac or large vessel rupture, aortic dissection or large vessel rupture, pericardial incision syndrome.

(6) The cause is unknown

Acute non-specific pericarditis.

(7) Self-immune pericarditis.

an examination

Related inspection

M-mode echocardiography (ME) dynamic electrocardiogram (Holter monitoring) serous effusion pathogen magnetic resonance angiography angiography

The normal pericardial cavity contains 25-30 ml of liquid (maximum of 50 ml). For any reason, the amount of fluid in the pericardial cavity increases. More than 50 ml, the pericardial effusion appears. The clinical manifestations of pericardial effusion are mainly in the pericardial cavity. The amount of liquid, the rate of growth of liquid accumulation, and the characteristics of the pericardium.

1. X-ray examination: 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, the shadow of the superior vena cava is widened, and the heart beats weakly under the fluoroscopy. Wild clarity can be signed with heart failure.

2, ECG: often have 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, then effusion) It is a small amount; if it is between 10-19 mm, it is a medium amount '; if it is more than 20 mm, it is a large amount).

4, pericardial puncture: can confirm the presence of pericardial effusion, relieve the symptoms of pericardial tamponade. Retain some effusion for laboratory tests of related causes.

Differential diagnosis

Differential diagnosis of pericardial fluid signs:

Pleural effusion fluid sign: There may be pleural friction sound when a small amount of fluid is accumulated. The affected side is full of thoracic, respiratory movement is weakened, percussion turbidity and respiratory sounds are weakened or disappeared. The upper edge of the medial effusion percussion dullness can sometimes smell bronchial breath sounds, and a large amount of effusion trachea shifts to the healthy side.

The normal pericardial cavity contains 25-30 ml of liquid (maximum of 50 ml). For any reason, the amount of fluid in the pericardial cavity increases. More than 50 ml, the pericardial effusion appears. The clinical manifestations of pericardial effusion are mainly in the pericardial cavity. The amount of liquid, the rate of increase in fluid accumulation, and the characteristics of the pericardium.

1. X-ray examination: the heart shadow is generally enlarged to both sides (more than 300 ml of effusion); when the effusion (more than 1000 ml), the heart shadow is in the form of a flask, the shadow of the superior vena cava is widened, and the heart beats weakly under the fluoroscopy. Wild clarity can be signed with heart failure.

2, ECG: often have 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, then effusion) It is a small amount; if it is between 10-19 mm, it is a medium amount '; if it is more than 20 mm, it is a large amount).

4, pericardial puncture: can confirm the presence of pericardial effusion, relieve the symptoms of pericardial tamponade, and retain part of the effusion for laboratory tests of related causes.

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