Description

Inflammation of the pericardium, usually resulting in the accumulation of fluid in the pericardial space between the visceral (serosal tissue intimately related to the myocardium) and parietal (fibrous layer composed of elastic fibers and collagen) pericardium. Pericarditis may be serous, fibrinous, purulent, hemorrhagic, or chylous.

Epidemiology

• Infectious pericarditis is more frequently seen in children <13 years of age, with predominance in children <2 years of age.
• 2 to 3/1,000 hospitalized children have pericarditis.
• 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.

Pathophysiology

• 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.
• Effusion is defined as excessive pericardial contents secondary to inflammation, hemorrhage, exudates, air, or pus.
• In postpericardiotomy syndrome, there appears to be a nonspecific hypersensitivity reaction to the direct surgical entrance into the pericardial space.

Etiology

• Infectious
  • Viral: coxsackievirus, echovirus, mumps, varicella, Epstein-Barr, adenovirus, influenza, HIV
  • 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
  • Lymphoma
  • Lymphosarcoma
  • Leukemia
  • Sarcoma
  • Metastatic disease to the pericardium
  • Radiation therapy–induced
• Postoperative
  • Postpericardiotomy syndrome (after cardiac surgery)
  • Chylopericardium
• Other
  • Trauma
  • Drug-induced (hydralazine, isoniazid, procainamide)
  • Aortic dissection
  • Postmyocardial infarction
  • Idiopathic