Pericardial Effusion

Pericardial effusion (“fluid around the heart”) is an abnormal accumulation of fluid in the pericardial cavity or between the heart and the pericardium, which is the membrane sac that envelops the heart.

Although normally there is a very small amount of pericardial fluid, a large pericardial effusion puts pressure on the heart and prevents it from functioning properly. Extreme fluid accumulation can cause a life-threatening condition called cardiac tamponade, a condition where the heart can’t fill and can’t pump blood effectively.

UT Southwestern Medical Center’s specialized thoracic surgeons offer leading-edge procedures to treat pericardial effusion – some of which can be performed minimally invasively. Our surgeons work closely with UT Southwestern’s cardiologists and heart surgeons to deliver comprehensive care – all in one location, and usually on the same day.

Causes

Causes of pericardial effusion include:

  • Autoimmune disorders, such as rheumatoid arthritis or lupus
  • Cancer of the pericardium or heart
  • Certain prescription drugs, including hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin, a medication for epileptic seizures
  • Chemotherapy treatment for cancer, such as doxorubicin and cyclophosphamide
  • Inflammation of the pericardium following heart surgery or a heart attack
  • Radiation therapy for cancer if the heart was within the field of radiation
  • Spread of cancer (metastasis), particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin's lymphoma, or Hodgkin's disease
  • Trauma or puncture wound near the heart
  • Underactive thyroid (hypothyroidism)
  • Viral, bacterial, fungal, or parasitic infections
  • Waste products in the blood due to kidney failure (uremia)

Symptoms

Pericardial effusion doesn’t always cause symptoms. The volume of fluid and rate of accumulation often determine the presence of symptoms, and include:

  • Anxiety and confusion
  • Chest pain, pressure, or discomfort
  • Feeling of abdominal fullness
  • Heart palpitations
  • Lightheadedness or fainting (syncope)
  • Nausea
  • Restlessness
  • Shortness of breath
  • Swelling in the abdomen and legs

Diagnosis

If we suspect that you have pericardial effusion, we will conduct a physical examination and order studies to confirm the diagnosis. Diagnostic studies may include:

Treatments

Definitive treatment of pericardial effusion is directed at the etiology, or its cause. A small amount of fluid around the heart may not require treatment or may be controlled with medications. However, for some patients surgery is the most appropriate option.

Echocardiography (ultrasound of the heart) is used to estimate the amount of fluid and to determine its effect on heart function. The fluid may be drained to help identify the cause of the fluid accumulation and to relieve the pressure on the heart. The relief of the pressure may be temporary and another drainage procedure may be necessary for some patients; in that case, a temporary catheter may be placed.

Our highly skilled thoracic surgeons treat pericardial effusions with minimally invasive procedures that include:

  • Video-assisted thoracoscopic surgery (VATS) or thoracoscopic pericardial window – enables surgeons to see a wider area of the pericardium (the sac than surrounds the heart) and the pleural region through two-to-four very small (5 mm), strategically-placed incisions; these small incisions heal more quickly and cause less pain than larger incisions. We create a sufficiently large opening or window in the pericardium to allow the fluid to naturally drain internally and avoid collection in the pericardium.
  • Pericardial window (subxiphoid pericardiostomy) – a 4-5 cm vertical linear incision is made at the highest point in the midline abdomen (below the end of the breastbone) in order to open the pericardium and allow the fluid to drain internally or externally to relieve pressure on the heart. The pericardial window can be performed in less than 30 minutes and patients can often return home the next day. Very small drains that are placed to eliminate the fluid are removed in the outpatient clinic.

Related Conditions

We treat the thoracic (chest) conditions that can be associated with pericardial effusion, including:

  • Metastatic disease (spread of tumor beyond the site of origin)
  • Metastasectomy (removal of a metastatic deposit)
  • Malignant pericardial effusion (pericardial fluid accumulation caused by a cancerous tumor)
  • Malignant pleural effusion (pleural fluid accumulation caused by a cancerous tumor)

Clinical Trials

In addition to standard treatments for pericardial effusion, UT Southwestern gives patients access to the most promising new therapies through clinical trials. Talk with your doctor to see if a clinical trial may be right for you.

Meet Our Team

Thoracic surgeons at UT Southwestern who treat pericardial effusion include:

Learn more about our Thoracic Surgery team.

Request an Appointment

To schedule an appointment with a pericardial effusion specialist at UT Southwestern’s facilities in Dallas or to learn more about our services, request an appointment or call 214-645-8300.