Diagnosis | Water in the pericardium – Dangerous?

Diagnosis

The method of choice for the diagnosis of pericardial effusion is ultrasound diagnostics (sonography), in which the water in the pericardium can be visualized. Computer tomography (CT) can also be used to visualize fluid between the two pericardium layers. After visual confirmation of water accumulation, fluid is usually taken from the pericardial cavity (puncture) to examine it for possible pathogens or cancer cells. The accumulation of fluid can also be noticed in the ECG, and those affected often show a reduced rash in the ECG recording.

Complications

The dreaded complication of water accumulation in the pericardium is the so-called pericardial tamponade. This is a massive functional disorder of the heart, which is caused by a very strong accumulation of fluid in the pericardium. The heart is then barely able to pump properly, the ventricles are hardly filled with blood and the blood supply to the heart is barely ensured by compression. In extreme cases, this can even lead to life-threatening circumstances when not enough blood can be expelled from the heart to supply the body.

Therapy

The therapy of pericardial effusion can be very variable and depends largely on the underlying cause. Small accumulations of fluid in the pericardium usually do not require therapy, larger ones should be relieved by means of punctures to avoid complications. In this procedure, the treating physician inserts a needle into the chest under ECG control and advances it into the pericardium, where it is then withdrawn from the pericardium via a cannula.

However, if the amount of fluid is so large that it cannot be removed by a simple puncture, it is also possible to place a pericardial drainage into the pericardium, which then drains the fluid continuously through a kind of catheter. If the pericardial effusion is infectious, the administration of antibiotics or anti-inflammatory painkillers is often indicated. However, if no conservative therapy is indicated or if recurrent effusions occur, often only a surgical intervention can provide relief: This involves cutting a kind of small hole or window in the pericardium (pericardial windowing), through which the accumulated fluid can escape.

Only in very rare cases may a complete removal of the pericardium (pericardiocentesis) be necessary. If there is water in the pericardium, this can very quickly lead to serious complications. For example, a narrowing of the heart leads to a loss of function with a significantly reduced amount of blood being pumped into the circulation.

Occasionally, a conservative (wait-and-see) therapy is sufficient by treating the cause of the water retention. Often, however, a puncture is necessary. During this procedure, the water can be drained from the pericardium.

In most cases, the fluid from the pericardium is also used for further examinations. The puncture is usually performed ultrasonically with a long needle or syringe. With the syringe, the fluid can be collected directly so that it can be used for further diagnostic purposes.