Pericarditis

DESCRIPTION

Inflammation of the pericardium, usually resulting in fluid accumulation within the pericardial space between the visceral (serosal tissue intimately related to the myocardium) and parietal (fibrous layer composed of elastic fibers and collagen) pericardium; this inflammation can be limited to the pericardium, can be associated with myocarditis, or can be a part of a systemic disease.

EPIDEMIOLOGY

• Infectious pericarditis is more frequently seen in children <13 years of age, with predominance in children <2 years of age.
• Adolescent males constitute the majority of children hospitalized with idiopathic or viral pericarditis.
• Postpericardiotomy syndrome occurs in ~5–10% of children following uncomplicated cardiac surgery, particularly when the atrium has been entered. It occurs between 1 and 4 weeks postoperatively.

ETIOLOGY

• Infectious
  • Viral: coxsackievirus, echovirus, mumps, varicella, Epstein-Barr virus (EBV), adenovirus, influenza, HIV, coronavirus including SARS-CoV-2
  • Bacterial: Streptococcus, pneumococcus, Staphylococcus (most common cause of bacterial pericarditis), meningococcus, Mycoplasma, tularemia, Haemophilus influenzae type B, Pseudomonas aeruginosa, Listeria monocytogenes, Pasteurella multocida, Escherichia coli
  • Tuberculosis, atypical mycobacterium
  • Fungal: candidiasis, histoplasmosis, actinomycosis
  • Parasitic: toxoplasmosis, Echinococcus, Entamoeba histolytica, Rickettsia
• Rheumatologic/inflammatory
  • Acute rheumatic fever
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Systemic sclerosis
  • Sarcoidosis
  • Dermatomyositis
  • Kawasaki disease
  • Familial Mediterranean fever
  • Inflammatory bowel disease
• Metabolic/endocrine
  • Hypothyroidism
  • Uremia (chemical irritation)
  • Gout
  • Scurvy
• Neoplastic disease (e.g., lymphoma, lymphosarcoma, leukemia, sarcoma, metastatic disease to the pericardium)
• Postoperative
  • Postpericardiotomy syndrome (after cardiac surgery, intervention, or ablation)
  • Chylopericardium
• Other
  • Trauma
  • Drug-induced (hydralazine, isoniazid, procainamide)
  • Aortic dissection
  • Postmyocardial infarction
  • Radiation therapy–induced
  • Idiopathic

PATHOPHYSIOLOGY

• Exaggerated inflammatory response secondary to environmental triggers and immune system
• Fine deposits of fibrin develop next to the great vessels, leading to altered function of the membranes of the pericardium, including changes in oncotic and hydrostatic pressure with subsequent accumulation of fluid in the pericardial space.
• Postpericardiotomy syndrome is probably related to an autoimmune reaction in the setting of acute or reactivated viral illness.