Pericardial disease

Although an anatomically inert structure, pathology affecting the pericardium carries substantial morbidity and potential mortality, largely due to effects on underlying cardiac function. Acute pericarditis has a variety of causes though a non-specific origin with benign prognosis is most common. Tuberculosis is a frequent cause in the developing world where frequency is increasing as a result of the HIV epidemic. Disabling or life threatening complications of pericarditis may arise as a result of cardiac compression, including pericardial effusion with tamponade, pericardial fibrosis or calcification (resulting in constrictive physiology) or a combination of effusion and constriction. Large pericardial effusions may be well tolerated though the development of tamponade is a clinical emergency usually requiring percutaneous pericardioscentesis. Surgery is occasionally necessary, particularly for recurrence. Constrictive pericarditis is increasingly rare in regions where tuberculosis has been largely eradicated. Diagnosis is difficult and differentiation from restrictive cardiomyopathy, particularly challenging. Complete pericardial resection is the only definitive treatment and surgery is technically demanding with high mortality.