Hydropericardium

HYDROPERICARDIUM (hydropericardium), or dropsy of the pericardial sac (hydrops pericardii), is an accumulation of non-inflammatory fluid (transudate) in the pericardial cavity in amounts exceeding the norm (20–30 cubic centimeters). It is observed in venous congestion, general dropsy resulting from heart or kidney diseases, cachexia of various origins (for example, in tuberculosis and cancer patients), and anemias. The development of hydropericardium is caused either by abnormally increased permeability for plasma in the vessels of the pericardium, or by the impairment of the normal absorption of pericardial fluid by the layers of the pericardium (e.g., in venous congestion), or by both factors simultaneously. Finally, some authors note the possibility of hydropericardium developing in cachectic patients due to the fact that the diminished heart insufficiently fills the pericardial sac (hydrops ex vacuo). The amount of fluid in hydropericardium rarely exceeds 150–200 cubic centimeters; its accumulation in larger quantities, according to Curschmann and Romberg, should always raise suspicion of the addition of inflammatory changes in the pericardium. The fluid in hydropericardium has the character of a transudate: it is transparent, yellowish in color, poor in protein, sometimes contains traces of fibrin, a small number of lymphocytes, isolated swollen endothelial cells, and sometimes isolated erythrocytes. Macroscopically, the pericardium is unchanged, sometimes only slightly edematous; microscopically, there is occasional slight swelling and desquamation of the endothelium. Clinically, hydropericardium is rarely diagnosed because the small amount of fluid accumulating in the pericardial cavity usually does not significantly affect either the work of the heart or the character of auscultation and percussion data. More often, but far from always, one can ascertain a percussion increase in cardiac dullness, approaching the typical shape of the heart in pericarditis (see). The presence of hydropericardium can always be suspected in cases with an abundant accumulation of fluid in the thoracic cavity, even in the absence of direct indications of hydropericardium. When diagnosing hydropericardium, one must keep in mind the possibility of confusing it with serous pericarditis, especially of uremic origin. Therapy and prognosis in hydropericardium are determined by the underlying disease. Puncture of the pericardium is almost never resorted to, except in cases with excessively large accumulation of fluid in the pericardial cavity that impedes heart function, which as a rule does not occur in pure hydropericardium not complicated by an admixture of inflammatory phenomena.