Pericardial effusion pathophysiology

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


Pericardial effusion usually results from a disturbed equilibrium between the production and reabsorption of pericardial fluid. This can occur in infections and inflammations where there is increased production of pericardial fluid, increased microvascular pressure as in cardiac failure and renal failure cause, decreased plasma oncotic pressure as in cirrhosis and nephrotic syndrome, or in malignancy and hypothyroidism where there is inadequate drainage of the fluid.



  • Pericardium surrounds the heart and it consists of two layers, parietal and visceral layers [1].
  • The space between the layers is known as the pericardial cavity.
  • It usually contains small amount of fluid, approximately 15-50ml, which acts as a lubricating agent between the layers.
  • This fluid enters the pericardial space from the capillaries into the visceral pericardium.
  • This fluid is drained by lymphatics [2].
  • When this fluid production-drainage mechanism is altered, excess fluid accumulates in the pericardial cavity and this is referred to as pericardial effusion.
Normal gross anatomy of the pericardium space and fluid. Credit: Anatomist90 [3]


Therefore, pericardial effusion occurs when there is:

  • Increased capillary membrane permeability: Infection or inflammation may lead to exudative fluid or hemorrhagic effusion which have high protein levels. The pericardial effusion observed in the following conditions results from increased permeability of the capillary membrane [4].


There are no known genetic causes of pericardial effusion.

Associated Conditions

Conditions associated with pericardial effusion include:

Gross Pathology

On gross pathology, enlarged cardiac cavity, compressed cardiac chambers (with large effusions), heart swinging within the effusion fluid are characteristic findings of pericardial effusion. Further, the color of the effusion fluid may give an insight into the possible effusion cause.

Microscopic Pathology

On microscopic histopathological analysis, there are no characteristic features of pericardial effusion. However, analysis of the pericardial fluid itself may give insights into the underlying cause e.g. numerous pus cells would indicate a pyogenic/inflammatory cause, lymphocytes indicate viral infection, and malignant cells indicate malignant seeding into the pericardium.


  1. Hoit BD (2017). "Anatomy and Physiology of the Pericardium". Cardiol Clin. 35 (4): 481–490. doi:10.1016/j.ccl.2017.07.002. PMID 29025540.
  2. Rodriguez ER, Tan CD (2017). "Structure and Anatomy of the Human Pericardium". Prog Cardiovasc Dis. 59 (4): 327–340. doi:10.1016/j.pcad.2016.12.010. PMID 28062264.
  4. Vakamudi S, Ho N, Cremer PC (2017). "Pericardial Effusions: Causes, Diagnosis, and Management". Prog Cardiovasc Dis. 59 (4): 380–388. doi:10.1016/j.pcad.2016.12.009. PMID 28062268.
  5. Patel Y, Agarwal V, Argulian E (2018). "Relation of Blood Pressure to Severity of Pericardial Effusion". Am J Cardiol. 121 (11): 1409–1412. doi:10.1016/j.amjcard.2018.02.023. PMID 29580632.
  6. Scardulla F, Rinaudo A, Pasta S, Scardulla C (2015). "Mechanics of pericardial effusion: a simulation study". Proc Inst Mech Eng H. 229 (3): 205–14. doi:10.1177/0954411915574012. PMID 25833996.
  7. Refaat MM, Katz WE (2011). "Neoplastic pericardial effusion". Clin Cardiol. 34 (10): 593–8. doi:10.1002/clc.20936. PMC 6652358 Check |pmc= value (help). PMID 21928406.

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