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What Causes Pericardial Effusions?

Pericardial effusion may be caused by mesothelioma tumors growing on the heart lining (pericardium).

Other causes of pericardial effusion include:

  • Pleural mesothelioma or other cancers of the chest
  • Inflammation of the heart lining
  • Bacterial, viral, fungal or parasitic infection
  • Certain chemotherapy drugs such as doxorubicin and cyclophosphamide
  • Radiation therapy
  • Underactive thyroid
  • Inflammation
  • Infection
  • Other primary cancers of the chest

Pericardial effusion is a common symptom of pericardial mesothelioma, a rare cancer that forms in the lining of the heart.

This lining, known as the pericardium, is made up of two layers. Normally, a small amount of fluid exists between these layers to lubricate the lining and offer protection around the heart.

What Are the Symptoms of Pericardial Effusions?

Not everyone with pericardial effusion will experience symptoms.

Symptoms of pericardial effusion include:

  • Shortness of breath or breathing difficulties
  • Uncomfortable breathing while lying down
  • Chest pain (commonly on the left side)
  • A sense of fullness or pressure in the chest

Excess fluid can increase pressure on the heart, a condition called cardiac tamponade. This prevents the chambers from filling completely and results in poor circulation and inadequate oxygen supply.

A 2021 case study of a 64-year-old woman with a history of radiation therapy for breast cancer developed malignant pericardial mesothelioma. The recurrent bloody pericardial effusion worsened and caused generalized swelling and shortness of breath at night. 

Treatment for pericardial effusion involves minor or major surgical procedures.

Pericardial Effusion Treatment

Pericardial effusion caused by mesothelioma is treated with procedures that drain the fluid or surgically remove the lining where the fluid collects.

Pericardiocentesis

pericardiocentesis is a minor surgical procedure that drains fluid from around the heart.

Process of a Pericardiocentesis

  1. A local anesthetic is administered.
  2. A thin needle is inserted into the pericardial lining and guided by a heart ultrasound to ensure accuracy and prevent injury.
  3. The needle is replaced by a catheter.
  4. The catheter drains the excess fluid, which may take several hours.

There is a chance the fluid could return after a pericardiocentesis. Patients with recurring pericardial effusion may be candidates for a pericardiectomy to prevent recurrence.

In a 2017 case report, a pericardial mesothelioma patient with pericardial effusion was treated with a pericardiocentesis. The procedure successfully resolved the effusion and the patient went on to receive chemotherapy for six months. Two years later the patient was still alive receiving only supportive care.

Pericardiectomy

pericardiectomy, or pericardial window, is a surgery that removes part or all of the heart lining. It is used to treat pericardial effusion, inflammation of the pericardium (pericarditis) and pericardial mesothelioma.

There are two types of pericardiectomies:

  • A partial pericardiectomy removes a diseased portion of the heart lining.
  • A total pericardiectomy removes nearly all of the lining.

The surgery prevents fluid from accumulating again. Recovery in the hospital takes one to two weeks.


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