Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Etiology of pericardial disease

Brian D Hoit, MD
Section Editors
Martin M LeWinter, MD
Jae K Oh, MD
Deputy Editor
Brian C Downey, MD, FACC


The normal pericardium is a fibroelastic sac surrounding the heart that contains a thin layer of fluid. Diseases of the pericardium may be isolated to the pericardium or associated with a number of systemic disorders. The principal manifestations of pericardial disease are pericarditis (an acute, subacute, or chronic fibrinous process) and pericardial effusion, as well as long-term complications such as cardiac tamponade and constrictive pericarditis. In some cases, the clinical presentation of acute pericardial inflammation predominates, and the presence of excess pericardial fluid is clinically unimportant. In other cases, the effusion and its clinical consequences (ie, cardiac tamponade and constrictive pericarditis) are of primary importance.

This topic will provide a brief overview of the major causes of pericardial disease. Details of the specific pericardial disorders are discussed separately. (See "Clinical presentation and diagnostic evaluation of acute pericarditis" and "Diagnosis and treatment of pericardial effusion" and "Constrictive pericarditis".)


The etiology of pericardial diseases is best considered by using a modification of the time-honored pathologic classification of disease into inflammatory, neoplastic, vascular, congenital, and idiopathic causes (table 1) [1-3]. The major causes include:


Viral, including HIV


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue May 05 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Spodick DH. The Pericardium: A Comprehensive Textbook, Marcel Dekker, New York 1997. p.260.
  2. Spodick DH. Pericardial disease. In: Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald E, Zipes D, Libby P (Eds), Saunders, New York 2001. p.183.
  3. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004; 363:717.
  4. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol 1985; 56:623.
  5. Zayas R, Anguita M, Torres F, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995; 75:378.
  6. Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109:95.
  7. Corey GR, Campbell PT, Van Trigt P, et al. Etiology of large pericardial effusions. Am J Med 1993; 95:209.
  8. Levy PY, Corey R, Berger P, et al. Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore) 2003; 82:385.
  9. Atar S, Chiu J, Forrester JS, Siegel RJ. Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? Chest 1999; 116:1564.
  10. Ben-Horin S, Bank I, Guetta V, Livneh A. Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. Medicine (Baltimore) 2006; 85:49.
  11. Campbell PT, Li JS, Wall TC, et al. Cytomegalovirus pericarditis: a case series and review of the literature. Am J Med Sci 1995; 309:229.
  12. Chen Y, Brennessel D, Walters J, et al. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 1999; 137:516.
  13. Stewart JR, Fajardo LF, Gillette SM, Constine LS. Radiation injury to the heart. Int J Radiat Oncol Biol Phys 1995; 31:1205.
  14. Applefeld MM, Wiernik PH. Cardiac disease after radiation therapy for Hodgkin's disease: analysis of 48 patients. Am J Cardiol 1983; 51:1679.
  15. Galve E, Garcia-Del-Castillo H, Evangelista A, et al. Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance. Circulation 1986; 73:294.
  16. Correale E, Maggioni AP, Romano S, et al. Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI). Am J Cardiol 1993; 71:1377.
  17. Belkin RN, Mark DB, Aronson L, et al. Pericardial effusion after intravenous recombinant tissue-type plasminogen activator for acute myocardial infarction. Am J Cardiol 1991; 67:496.
  18. Shahar A, Hod H, Barabash GM, et al. Disappearance of a syndrome: Dressler's syndrome in the era of thrombolysis. Cardiology 1994; 85:255.
  19. Jerjes-Sánchez C, Ramírez-Rivera A, Ibarra-Pérez C. The Dressler syndrome after pulmonary embolism. Am J Cardiol 1996; 78:343.
  20. Stevenson LW, Child JS, Laks H, Kern L. Incidence and significance of early pericardial effusions after cardiac surgery. Am J Cardiol 1984; 54:848.
  21. Hauptman PJ, Couper GS, Aranki SF, et al. Pericardial effusions after cardiac transplantation. J Am Coll Cardiol 1994; 23:1625.
  22. Quin JA, Tauriainen MP, Huber LM, et al. Predictors of pericardial effusion after orthotopic heart transplantation. J Thorac Cardiovasc Surg 2002; 124:979.
  23. Rostand SG, Rutsky EA. Pericarditis in end-stage renal disease. Cardiol Clin 1990; 8:701.
  24. Gunukula SR, Spodick DH. Pericardial disease in renal patients. Semin Nephrol 2001; 21:52.
  25. Kabadi UM, Kumar SP. Pericardial effusion in primary hypothyroidism. Am Heart J 1990; 120:1393.
  26. Wilkes JD, Fidias P, Vaickus L, Perez RP. Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer 1995; 76:1377.
  27. Porte HL, Janecki-Delebecq TJ, Finzi L, et al. Pericardoscopy for primary management of pericardial effusion in cancer patients. Eur J Cardiothorac Surg 1999; 16:287.
  28. Mandell BF. Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum 1987; 17:126.
  29. Berti A, Ferrarini M, Ferrero E, Dagna L. Cardiovascular manifestations of Erdheim-Chester disease. Clin Exp Rheumatol 2015; 33:S.
  30. Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion. Eur Heart J 2002; 23:1481.
  31. Maisch B, Ristić AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J 2002; 23:1503.