Aantigens.

Both types can lead to an associated effusion, though

the incidence is declining in the era of early revascularization.

Similarly, as many as a third of patients may develop an

autoimmune-mediated pericarditis after cardiac surgery.

Metabolic diseases can also cause pericardial effusions, often

with associated signs and symptoms that aid in the diagnosis.

Uremia can cause an inflammatory pericardial effusion characterized

by hemorrhagic pericardial fluid and fibrinous exudates

attached to the pericardium. The primary treatment is hemodialysis,

and in the developed world, effusions caused by uremic

pericarditis are becoming less common, as most patients have

earlier initiation of hemodialysis. Other non-inflammatory

metabolic causes of pericardial effusions include hypothyroidism

and severe protein malnutrition. In the absence of pericardial

tamponade, primary treatment includes replacement of thyroid

hormone and proper nutrition, respectively.

Pericardial fluid can also accumulate in non-inflammatory

processes with high systemic venous pressures, such as

congestive heart failure and cirrhosis. In these diseases,

decreased reabsorption can lead to transudative effusions.

Often, these patients do not have symptoms referable to their

pericardial effusions, and the effusion may be discovered

incidentally on imaging.

Finally, hemorrhagic pericardial effusions can result from

blunt force or penetrating trauma to the chest. Thoracic aortic

dissections can also extend to the aortic root with retrograde

bleeding into the pericardium. Cardiac procedures that are

complicated by myocardial or coronary perforation can also

result in a hemorrhagic pericardial effusion. In cases of acute

hemorrhage, due to rapid accumulation of fluid, pericardial