Etiology of Pericardial Disease – Seek It, or You Shall not Find It!

The pericardial sac consists of fibroelastic layers, known as the visceral and parietal layers, separated by the pericardial cavity. This cavity typically contains 15 to 50 ml of a plasma-derived ultrafiltrate in healthy individuals. Pericardial diseases are relatively common in clinical practice, presenting either in isolation or as a part of systemic disorders.

The causes of these diseases vary and are intricate, but the pericardium typically responds with inflammation of its layers and potential increased production of pericardial fluid. Persistent inflammation may lead to a stiffened and calcified pericardium, often thickened, with possible progression to pericardial constriction. In some instances, acute pericardial inflammation dominates the clinical presentation, rendering excess pericardial fluid less relevant. In contrast, in other cases, the accumulation of fluid and its clinical consequences, such as cardiac tamponade and constrictive pericarditis, take center stage. Congenital abnormalities like the absence of the pericardium and pericardial cysts are generally rare and asymptomatic. Despite the non-essential nature of the pericardium for normal cardiac function, diseased pericardium, presenting as acute or recurrent pericarditis, pericardial effusion, cardiac tamponade, and pericardial constriction, can pose significant challenges in management and even become life-threatening.

[…]