This image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film

Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.

This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).

This electrocardiogram (ECG) is from a patient with malignant pericardial effusion. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.

Subcostal view of an echocardiogram that shows a moderate to large amount of pericardial effusion.

This echocardiogram shows a large amount of pericardial effusion (identified by the white arrows).

1. Montaudon M, Roubertie F, Bire F, Laurent F. Congenital pericardial defect: report of two cases and literature review.Surg Radiol Anat. Apr 2007;29(3):195-200.[Medline].2. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era.Ann Thorac Surg. Oct 2002;74(4):1148-53.[Medline].3. Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998.Chest. Aug 1999;116(2):322-31.[Medline].4. Ciliberto GR, Anjos MC, Gronda E, Bonacina E, Danzi G, Colombo P, et al. Significance of pericardial effusion after heart transplantation.Am J Cardiol. Aug 1 1995;76(4):297-300.[Medline].5. Rosenbaum E, Krebs E, Cohen M, et al. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review.Lupus. Jun 2009;18(7):608-12.[Medline].6. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases.J Clin Pathol. Jan 2007;60(1):27-34.[Medline].7. Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P. Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS.Pediatr Cardiol. Nov 14 2009;[Medline].8. Lind A, Reinsch N, Neuhaus K, et al. Pericardial effusion of HIV-infected patients ? Results of a prospective multicenter cohort study in the era of antiretroviral therapy.Eur J Med Res. Nov 10 2011;16(11):480-3.[Medline].[Full Text].9. Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations.Am J Med Sci. Sep 2009;338(3):211-6.[Medline].10. Troughton RW, Asher CR, Klein AL. Pericarditis.Lancet. Feb 28 2004;363(9410):717-27.[Medline].11. Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation.Circulation. Aug 5 2008;118(6):667-71.[Medline].12. Permanyer-Miralda G, Sagrist-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients.Am J Cardiol. Oct 1 1985;56(10):623-30.[Medline].13. Ben-Horin S, Bank I, Shinfeld A, Kachel E, Guetta V, Livneh A. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis.Am J Cardiol. May 1 2007;99(9):1294-7.[Medline].14. Refaat MM, Katz WE. Neoplastic pericardial effusion.Clin Cardiol. Oct 2011;34(10):593-8.[Medline].15. Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A, et al. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients.Circulation. Oct 1 1996;94(7):1635-41.[Medline].16. Hoit BD. Pericardial disease and pericardial tamponade.Crit Care Med. Aug 2007;35(8 Suppl):S355-64.[Medline].17. Karia DH, Xing YQ, Kuvin JT, Nesser HJ, Pandian NG. Recent role of imaging in the diagnosis of pericardial disease.Curr Cardiol Rep. Jan 2002;4(1):33-40.[Medline].18. Horowitz MS, Schultz CS, Stinson EB. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion.Circulation. 1974;50:239-47.19. Faehnrich JA, Noone RB Jr, White WD, et al. Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities.J Cardiothorac Vasc Anesth. Feb 2003;17(1):45-50.[Medline].20. Taguchi R, Takasu J, Itani Y, Yamamoto R, Yokoyama K, Watanabe S, et al. Pericardial fat accumulation in men as a risk factor for coronary artery disease.Atherosclerosis. Jul 2001;157(1):203-9.[Medline].21. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects.J Clin Endocrinol Metab. Nov 2005;90(11):6300-2.[Medline].22. Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT.Radiographics. Nov-Dec 2007;27(6):1595-610.[Medline].23. Watanabe A, Hara Y, Hamada M, et al. A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening.Magn Reson Imaging. Apr 1998;16(3):347-50.[Medline].24. Spodick DH. Acute cardiac tamponade.N Engl J Med. Aug 14 2003;349(7):684-90.[Medline].25. Bruch C, Schmermund A, Dagres N, Bartel T, Caspari G, Sack S, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment.J Am Coll Cardiol. Jul 2001;38(1):219-26.[Medline].26. [Guideline] Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology.Eur Heart J. Apr 2004;25(7):587-610.[Medline].27. Meurin P, Tabet JY, Thabut G, Cristofini P, Farrokhi T, Fischbach M, et al. Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial.Ann Intern Med. Feb 2 2010;152(3):137-43.[Medline].28. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial.Circulation. Sep 27 2005;112(13):2012-6.[Medline].29. Imazio M, Cecchi E, Ierna S, Trinchero R. Investigation on Colchicine for Acute Pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design amd rationale.J Cardiovasc Med (Hagerstown). Aug 2007;8(8):613-7.[Medline].30. Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy.Eur Heart J. Oct 2002;23(19):1503-8.[Medline].31. Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years.Mayo Clin Proc. May 2002;77(5):429-36.[Medline].32. Klein SV, Afridi H, Agarwal D, Coughlin BF, Schielke LH. CT directed diagnostic and therapeutic pericardiocentesis: 8-year experience at a single institution.Emerg Radiol. Nov 2005;11(6):353-63.[Medline].33. Eichler K, Zangos S, Thalhammer A, et al. CT-guided pericardiocenteses: clinical profile, practice patterns and clinical outcome.Eur J Radiol. Jul 2010;75(1):28-31.[Medline].34. Palmer SL, Kelly PD, Schenkel FA, Barr ML. CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion.Am J Roentgenol. OCT 2009;193:W314-20.[Medline].35. Motas C, Motas N, Rus O, Horvat T. Left paraxiphoidian approach for drainage of pericardial effusions.Interact Cardiovasc Thorac Surg. Jan 2010;10(1):4-5.[Medline].[Full Text].36. Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions.Rev Bras Cir Cardiovasc. Mar 2009;24(1):44-9.[Medline].[Full Text].37. Allen KB, Faber LP, Warren WH. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.Ann Thorac Surg. Feb 1999;67(2):437-40.[Medline].38. Artom G, Koren-Morag N, Spodick DH, Brucato A, Guindo J, Bayes-de-Luna A, et al. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis.Eur Heart J. Apr 2005;26(7):723-7.[Medline].39. Barbaro G. Cardiovascular manifestations of HIV infection.Circulation. Sep 10 2002;106(11):1420-5.[Medline].40. Moore KL, Persaud TVN.Before We Are Born: Essentials of Embryology and Birth Defects. 4thed. 1993.41. Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis.Eur Heart J. May 2000;21(10):832-6.[Medline].42. Braunwald E. Cardiology: how did we get here, where are we today and where are we going?.Can J Cardiol. Oct 2005;21(12):1015-7.[Medline].43. Braunwald E, ed.Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders Company; 1997:1478-96.44. Cheitlin MD, Alpert JS, Armstrong WF. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in coll.Circulation. Mar 18 1997;95(6):1686-744.[Medline].45. Chen Y, Brennessel D, Walters J. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.Am Heart J. Mar 1999;137(3):516-21.[Medline].46. Chong HH, Plotnick GD. Pericardial effusion and tamponade: evaluation, imaging modalities, and management.Compr Ther. Jul 1995;21(7):378-85.[Medline].47. Eisenberg MJ, de Romeral LM, Heidenreich PA. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment.Chest. Aug 1996;110(2):318-24.[Medline].48. Fagan SM, Chan KL. Pericardiocentesis: blind no more! [editorial; comment].Chest. Aug 1999;116(2):275-6.[Medline].49. Feigenbaum, H.Echocardiography. 1994. 5thed. Philadelphia: Lea & Febiger; 556-74.50. Flores RM, Jaklitsch MT, DeCamp MM Jr. Video-assisted thoracic surgery pericardial resection for effusive disease.Chest Surg Clin N Am. Nov 1998;8(4):835-51.[Medline].51. Guberman BA, Fowler NO, Engel PJ. Cardiac tamponade in medical patients.Circulation. Sep 1981;64(3):633-40.[Medline].52. Heidenreich PA, Eisenberg MJ, Kee LL. Pericardial effusion in AIDS. Incidence and survival.Circulation. Dec 1 1995;92(11):3229-34.[Medline].53. Ilan Y, Oren R, Ben-Chetrit E. Etiology, treatment, and prognosis of large pericardial effusions. A study of 34 patients.Chest. Oct 1991;100(4):985-7.[Medline].54. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis.J Am Coll Cardiol. Dec 17 2003;42(12):2144-8.[Medline].55. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy.J Am Coll Cardiol. Mar 17 2004;43(6):1042-6.[Medline].56. Kasper D, Branunwald E, Fauci A, et al.Harrison's Principles of Internal Medicine. 16thed. McGraw-Hill Professional; 2005:1414-1420.57. Kimberly RP. Treatment. Corticosteroids and anti-inflammatory drugs.Rheum Dis Clin North Am. Apr 1988;14(1):203-21.[Medline].58. Kocheril AG, Luttmann C, Sadaniantz A. Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics.Cathet Cardiovasc Diagn. Dec 1991;24(4):286-7.[Medline].59. Lange RA, Hillis LD. Clinical practice. Acute pericarditis.N Engl J Med. Nov 18 2004;351(21):2195-202.[Medline].60. Little WC, Freeman GL. Pericardial disease.Circulation. Mar 28 2006;113(12):1622-32.[Medline].61. Maher EA, Shepherd FA, Todd TJ. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade.J Thorac Cardiovasc Surg. Sep 1996;112(3):637-43.[Medline].62. Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment.Curr Opin Cardiol. May 1994;9(3):379-88.[Medline].63. Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy.Eur Heart J. Oct 2002;23(19):1503-8.[Medline].64. Mangan CM. Malignant pericardial effusions: pathophysiology and clinical correlates.Oncol Nurs Forum. Sep 1992;19(8):1215-21.[Medline].65. Maruyama R, Yokoyama H, Seto T, Nagashima S, Kashiwabara K, Araki J, et al. Catheter drainage followed by the instillation of bleomycin to manage malignant pericardial effusion in non-small cell lung cancer: a multi-institutional phase II trial.J Thorac Oncol. Jan 2007;2(1):65-8.[Medline].66. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis.Circulation. Dec 6 2005;112(23):3608-16.[Medline].67. Merc J, Sagrist-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade.Am Heart J. Oct 1999;138(4 Pt 1):759-64.[Medline].68. Meyers DG, Bagin RG, Levene JF. Electrocardiographic changes in pericardial effusion.Chest. Nov 1993;104(5):1422-6.[Medline].69. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid.Chest. May 1997;111(5):1213-21.[Medline].70. Naqvi TZ, Huynh HK. A new window of opportunity in echocardiography.J Am Soc Echocardiogr. May 2006;19(5):569-77.[Medline].71. Nugue O, Millaire A, Porte H. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients.Circulation. Oct 1 1996;94(7):1635-41.[Medline].72. Pankuweit S, Ristic AD, Seferovic PM, Maisch B. Bacterial pericarditis: diagnosis and management.Am J Cardiovasc Drugs. 2005;5(2):103-12.[Medline].73. Press OW, Livingston R. Management of malignant pericardial effusion and tamponade.JAMA. Feb 27 1987;257(8):1088-92.[Medline].74. Retter AS. Pericardial disease in the oncology patient.Heart Dis. Nov-Dec 2002;4(6):387-91.[Medline].75. Ruiz-Garca J, Jimnez-Valero S, Moreno R, Galeote G, Snchez-Recalde A, Calvo L, et al. Percutaneous Balloon Pericardiotomy as the Initial and Definitive Treatment for Malignant Pericardial Effusion.Rev Esp Cardiol. Dec 21 2012;[Medline].76. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G. Long-term follow-up of idiopathic chronic pericardial effusion.N Engl J Med. Dec 30 1999;341(27):2054-9.[Medline].77. Shabetai R. Recurrent pericarditis: recent advances and remaining questions.Circulation. Sep 27 2005;112(13):1921-3.[Medline].78. Silva-Cardoso J, Moura B, Martins L. Pericardial involvement in human immunodeficiency virus infection.Chest. Feb 1999;115(2):418-22.[Medline].79. Spodick DH. Acute pericarditis: current concepts and practice.JAMA. Mar 5 2003;289(9):1150-3.[Medline].80. Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion.Eur Heart J. Oct 2002;23(19):1481-2.[Medline].81. Spodick DH. The technique of pericardiocentesis. When to perform it and how to minimize complications.J Crit Illn. Nov 1995;10(11):807-12.[Medline].82. Vaitkus PT, Herrmann HC, LeWinter MM. Treatment of malignant pericardial effusion.JAMA. Jul 6 1994;272(1):59-64.[Medline].83. Weisse AB, Desai RR, Rajihah G. Contrast echocardiography as an adjunct in hemorrhagic or complicated pericardiocentesis.Am Heart J. Apr 1996;131(4):822-5.[Medline].84. Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study.Circulation. Mar 1984;69(3):506-11.[Medline].85. Zhang P, Liegeois NJ, Wong C, et al. Altered cell differentiation and proliferation in mice lacking p57KIP2 indicates a role in Beckwith-Wiedemann syndrome.Nature. May 8 1997;387(6629):151-8.[Medline].1.