The document discusses pericardial effusion, which is an abnormal accumulation of fluid in the pericardial sac surrounding the heart. It can be caused by various conditions that obstruct fluid drainage or damage the pericardium, such as infection, malignancy, autoimmune diseases, or drugs. The document lists various infectious etiologies of pericardial effusion including bacteria, viruses, fungi, and protozoa. It also discusses non-infectious causes like cancer and connective tissue diseases. Routine testing of pericardial fluid includes cell count, glucose, protein and LDH levels to help determine the cause.

2.  Ultrafiltrate of plasma that lies within the pericardial sac,
acting as a lubricant between the visceral and parietal layer of
the pericardium.
 The space normally contains 15-50 mL of thin, clear, straw-
colored fluid
 Enriched in molecules from the myocardial interstitial fluid and
lymphatic drainage

3.  Abnormal accumulation of pericardial fluid can be
secondary to obstruction of fluid drainage, injury or
insult to the pericardium, infection, malignancy,
systemic or autoimmune processes, drugs, or
procedures.

4.  The etiology of pericardial effusion includes the following:
 Idiopathic pericarditis
 Infection
 Bacteria
 Staphylococcus, Streptococcus, Haemophilus, Neisseria, Chlamydia
 M tuberculosis (still prevalent in developing countries)
 Viral (coxsackievirus A and B, echovirus, adenovirus, HIV)
 Fungal – Aspergillus, Candida, Histoplasma, Blastomycosis,
Coccidioidomycosis
 Protozoan – Echinococcus, Amebiasis, Toxoplasmosis
 Neoplasms
 Metastatic/paraneoplastic (breast, lung, leukemia, lymphoma)
 Primary – Teratoma, lipoma, angioma, rhabdomyosarcoma
 Autoimmune connective tissue disease

5.  The following conditions are associated with elevated WBC
counts:
 Elevated levels of leukocytes (>10,000/mcl) with neutrophil
predominance suggests a bacterial or rheumatic cause.
 The monocyte count is noted to be highest in malignant
effusions.
 Myxedema is associated with low WBC count.
 Elevated pericardial ADA activity is suggestive of TB
pericarditis.

6.  A low ratio of pericardial effusion (PE) and serum glucose
suggests infection. This low ratio, along with an elevated
neutrophil count in pericardial fluid, is suggestive for bacterial
pericardial effusion

7.  Routine panels are as follows:
 Cell count with differential
 Glucose level
 Pericardial fluid total protein
 Pericardial fluid lactate dehydrogenase (LDH)
 Serum Complement (anti-dsDNA, rheumatoid factor [RF],
antinuclear antibody [ANA])
 Gram stain and culture (at least 3 culture bottles from
pericardial fluid)

8.  Cytology (if malignancy is suspected)
 Tumor markers (if malignancy is suspected)
 Adenosine deaminase (if tuberculosis [TB] is suspected)
 Polymerase chain reaction (PCR) for Mycobacterium tuberculi
(if TB is suspected)
 Pericardial interferon-gamma (interferon-gamma) if TB is
suspected
 Viral cultures
 Molecular analysis (PCR) for bacteriological, viral, or fungal
agents
 B-type natriuretic peptide (BNP)