PERICARDIAL FLUID

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)