Pericardial effusion epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S., Abdelrahman Ibrahim Abushouk, MD[2]


The underlying cause of pericardial effusion depend on the region where the patient is living. While malignancy is the most common cause of pericardial effusion in developed countries, infections such as tuberculosis and HIV seems to be the main etiologies of pericardial effusion in developing countries.[1][2]

Epidemiology and Demographics


Pericardial effusion occurs commonly in fourth or fifth decade of life. However, it can occur in all age groups. Patients with AIDS are at higher risk of developing effusion earlier when compared to general population.[3]


There is no sexual predilection observed in occurrence of pericardial effusion.

Developed Countries

  • Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy.[4][5]
  • Among patients presenting with pericarditis or pericardial effusion with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%.[6][7][8]
  • Viral infection of the pericardium is another leading cause of pericardial effusion.[9][10][11] Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections, most commonly echovirus or coxsackie virus. In children, it is most commonly caused by adenovirus or coxsackie virus. The incidence and prevalence of viral pericardial effusion varies with season and region.

Developing Countries

  • Pericardial effusion secondary to HIV and tuberculosis is one of the major cause of acute pericarditis in developing countries.[12]
  • Tuberculous pericarditis, caused by mycobacterium tuberculosis, is found in approximately 1% of all autopsied cases of TB and in 1% to 2% of instances of pulmonary TB.[13] It accounted for 69.5% (162 of 233) of cases referred for diagnostic pericardiocentesis in a study in Western Cape Province of South Africa[14] while the same accounts for 4% of cases in developed countries.[15]
  • The incidence of pericardial effusion in patients with asymptomatic AIDS was 11% per year before the introduction of effective highly active antiretroviral therapy (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of CD4 count and albumin level.[16]


  1. Maisch B, Ristic A, Pankuweit S (2010). "Evaluation and management of pericardial effusion in patients with neoplastic disease". Prog Cardiovasc Dis. 53 (2): 157–63. doi:10.1016/j.pcad.2010.06.003. PMID 20728703.
  2. Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
  3. Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P (2010). "Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS". Pediatr Cardiol. 31 (2): 203–7. doi:10.1007/s00246-009-9584-1. PMID 19915889.
  4. Gornik HL, Gerhard-Herman M, Beckman JA (2005). "Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion". J Clin Oncol. 23 (22): 5211–6. doi:10.1200/JCO.2005.00.745. PMID 16051963.
  5. Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
  6. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J (1985). "Primary acute pericardial disease: a prospective series of 231 consecutive patients". Am J Cardiol. 56 (10): 623–30. PMID 4050698.
  7. Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A; et al. (2007). "Indicators of poor prognosis of acute pericarditis". Circulation. 115 (21): 2739–44. doi:10.1161/CIRCULATIONAHA.106.662114. PMID 17502574.
  8. Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E; et al. (2005). "Relation of acute pericardial disease to malignancy". Am J Cardiol. 95 (11): 1393–4. doi:10.1016/j.amjcard.2005.01.094. PMID 15904655.
  9. Troughton RW, Asher CR, Klein AL (2004). "Pericarditis". Lancet. 363 (9410): 717–27. doi:10.1016/S0140-6736(04)15648-1. PMID 15001332.
  10. Little WC, Freeman GL (2006). "Pericardial disease". Circulation. 113 (12): 1622–32. doi:10.1161/CIRCULATIONAHA.105.561514. PMID 16567581.
  11. Imazio M, Brucato A, Adler Y, Brambilla G, Artom G, Cecchi E; et al. (2007). "Prognosis of idiopathic recurrent pericarditis as determined from previously published reports". Am J Cardiol. 100 (6): 1026–8. doi:10.1016/j.amjcard.2007.04.047. PMID 17826391.
  12. Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). "Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature". Am Heart J. 137 (3): 516–21. PMID 10047635.
  13. Fowler NO (1991). "Tuberculous pericarditis". JAMA. 266 (1): 99–103. PMID 2046135.
  14. Reuter H, Burgess LJ, Doubell AF (2005). "Epidemiology of pericardial effusions at a large academic hospital in South Africa". Epidemiol Infect. 133 (3): 393–9. PMC 2870262. PMID 15962545.
  15. Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J (1988). "Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment". J Am Coll Cardiol. 11 (4): 724–8. PMID 3351140.
  16. Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB; et al. (1995). "Pericardial effusion in AIDS. Incidence and survival". Circulation. 92 (11): 3229–34. PMID 7586308.

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