Pericardial effusion occurs when fluid accumulates in the pericardial cavity surrounding the heart. Normally up to 50 mL of fluid is present but the cavity can hold up to 2 L if the fluid builds up slowly. Fluid accumulation can negatively impact heart function. There are four main types of pericardial effusion: transudative, exudative, hemorrhagic, and malignant. The two main causes are an imbalance of fluid pressures that allows fluid to leave blood vessels, or inflammation/injury of the pericardium. Symptoms include chest pain, fever, fatigue, and shortness of breath. Fluid is collected via pericardiocentesis and tested based on

1. Pericardial Effusion
• There is a sac around the heart that is called
pericardial membrane
• Pericardial effusion is an abnormal accumulation of
fluid in the pericardial cavity Because of the limited
amount of space in the pericardial
cavity fluid accumulation leads to an increased
intrapericardial pressure which can negatively
affect heart function

3. How much pericardial fluid is normal?
• Pericardial Effusion and Cardiac Tamponade.
The pericardial sac normally contains up to 50 mL
of fluid; it can hold 80 to 200 mL of fluid acutely, and
even up to 2 L if the fluid accumulates slowly.
Type of pericardial effusion
1) transudative
2) exudative
3) hemorrhagic
4) malignant (due to fluid accumulation caused
by metastasis)

4.  The two main reasons for fluid accumulation in the
pericardial space are
i. An imbalance between the pressure within blood
vessels—which drives fluid out of blood vessels—and
the amount of protein in blood—which keeps fluid in
blood vessels. The fluid that accumulates in this case is
called a transudate
ii. An injury or inflammation of the pericardium, in which
case the fluid that accumulates is called an exudate.
Conditions such as infections
.

5. • If the fluid is milky, consider the involvement
of the lymphatic system (ie,
chylopericardium). If the fluid is cloudy and
turbulent, it is suggestive of signs of increased
capillary leakage and leukocytosis and is
concerning for infectious effusion

6. causes
In most cases, inflammation of the sac, a
condition called pericarditis, leads to the effusion
1) Severe kidney failure, also called uremia
2) Autoimmune disease (lupus, rheumatoid
arthritis, and others)
3) Bacterial infections, including tuberculosis
4) Cancer
5) Injury to the sac or heart from a medical
procedure
6) Heart attack

7. Signs and symptoms
 the main symptom is chest pain. It may get
worse when you breathe
1) Fever
2) Fatigue
3) Muscle aches
4) Shortness of breath
5) Nausea, vomiting, and diarrhea (if you have a
virus)
6) Chest pain
7) pressure are common symptoms cardiac
tamponade

8. How is the sample collected for
testing?
• A healthcare practitioner uses a syringe and needle to collect a fluid
sample from the pericardial sac in a procedure
called pericardiocentesis.

10. Transportation of pericardial fluid
• Initially fluid is collected into a plain sterile
container for microbiology and chemical
pathology.
• A large volume should be submitted if
tuberculosis infection is suspected as much
fluid as possible should submitted for cytology
add heparin(at final conc.of 5u/ml of fluid)or
sodium citrate as an anticoagulant.

11. • A biopsy may be collected at the time of
aspiration and unfixed fluid sent for cell
surface marker if lymphoma is suspected.
• Refrigerate if more than 24 hour delay for
laboratory.
• Clinical information is necessary.

12. • Inflammatory conditions (including possible
bacterial viral and fungal infection) and
suspected primary or secondary neoplasm