Pericardial effusion
| Classification according to ICD-10 | |
|---|---|
| I30.- | Acute pericarditis |
| I31.3 | Pericardial effusion (non-inflammatory) |
| I09.2 | Chronic rheumatic pericarditis |
| C79.8 | Secondary malignant neoplasm in other specified locations |
| ICD-10 online (WHO version 2019) | |
A pericardial effusion or pericardial effusion is a pathological fluid accumulation in the pericardial sac . A small amount of fluid of around 2 to 10 ml in the pericardium is normal and not pathological. If this small amount is exceeded, one speaks of a pericardial effusion. There are acute and chronic pericardial effusions.
frequency
Pericardial effusion is a rather rare finding that is usually recognized by ultrasound. Pericardial effusions that are worth puncturing or needing puncture are even rarer. Pleural effusions are comparatively much more common than fluid accumulations in the pericardium.
causes
In the past, tubercular pericardial effusion was common; today, malignant effusions are in the foreground. Possible typical causes are:
- inflammatory-infectious
- inflammatory-rheumatic
- malignant (tumor cell colonization of the pericardium)
- after a heart attack
- uremic
- post-traumatic
- postoperatively
-
iatrogenic
- after a pacemaker implantation
- through a perforation during coronary dilation (expansion of the coronary arteries)
- after pulmonary vein isolation
- when treated with the anthracyclines daunorubicin or doxorubicin
complication
The life-threatening complication of pericardial effusion is pericardial tamponade . So much fluid has accumulated in the pericardium that the heart is prevented from performing its tasks and the heart muscle can only be insufficiently supplied with oxygen and nutrients via the coronary arteries .
Symptoms and Diagnosis
In the case of large pericardial effusions, the patients sit upright, are very anxious, have severe shortness of breath and congested jugular veins, there is usually cyanosis ; the pulse is small and soft. By tapping the chest just a very large effusion can be detected. The easiest and fastest way to detect an effusion is by ultrasound . A pericardial effusion can also be seen well on the CT . The fluid of the pericardial effusion can be examined cytologically for malignant cells and bacteria. Puncturing the pericardium is technically not easy. The larger the effusion, the easier and at the same time more important the puncture .
therapy
A small pericardial effusion does not require therapy. Depending on the cause, pericardial effusion can be treated with medication. In the case of larger pericardial effusions, therapeutic relief should be performed using a pericardial puncture . Furthermore, the following therapies are used for recurrent pericardial effusions. For example, a transcutaneous pericardiotomy is performed. This is done as with the puncture through the chest wall below the sternum. One can puncture the pericardial bag once or with a drainage - i. H. a drain hose - which can be left in place for several days. With the help of a catheter and a balloon, you can widen the small hole of the puncture catheter in the wall of the pericardium with compressed air. The advantage of this rarely used method is that an effusion can initially run off over a longer period of time and conventional treatment is possible.
See also
Web links
Individual evidence
- ↑ Alphabetical directory for the ICD-10-WHO Version 2019, Volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 687
- ^ Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition ibid. 1986, ISBN 3-13-352410-0 , pp. 206-208.
