Pericardial and Pleural Effusions

Question: 

I have had sinus inflammation/infections since November.  For the past three weeks, I have become breathless when walking/talking and also woke up at night not being able to take a deep breath.  Pain by the sternum when taking a deep breath started.  My Dr. Did a breathing test which showed my lung capacity was 60% of normal  I was put on nebulized meds. I used them for one week but they did not help at all.  I was getting worse.  My doctor ordered a ct of the chest.  I had the ct done this past Thursday.  The radiologist had me stay while he contacted my doctor.  I was at the cardiologist office two hours later having an echo and in the hospital Thursday night.  I had the effusion drained yesterday.

  1. Is one liter considered a lot of fluid?
  2. Could there be a relationship between chronically inflamed sinuses and the effusion?

Hi Amy, 

Re: Questions 1&2: Yes! The next question is to diagnose the cause of this pericardial effusion. The drainage only takes care of some of the symptoms, but for final treatment your doctor needs to find out what caused it and then try to eliminate the cause:

Pericarditis & pericardial effusion can result from one or more of these:

  • a viral, bacterial or fungal infection
  • heart attack
  • cancer spreading from a nearby tumor in the lung, breast or the blood
  • radiation treatment
  • injury or surgery

Sometimes it accompanies other diseases like rheumatoid arthritis (RA), lupus and kidney failure. In addition, there may be a Pleural Effusion as well.

In your case, I'd consider a viral illness related to your chronic sinus inflammation/infections. Your recovery depends on what treatment is needed. Infections and inflammations such as caused by RA take much longer to heal and can be more difficult to diagnose, because the effusion is usually only one of several manifestations of the primary disease.

Hope this helps,

Dr T

Comments

After the repeat echo, i was immediately readmitted as fluid redeveloped and was causing one chamber to collapse. I was transferred to a hospital with a cardiothoractoc team. I had a window and biopsy. The results of my pericardial biopsy showed chronic pericarditis and an acute flare. I have been tested by an infectious disease doctor, rheumatologist and immunologist. We still don't have a diagnosis however the immunologist suspects there is an underlying connective tissue disorder. I am most likely going to John Hopkins for a multi disciplinary evaluation. For the past 20 years I was dx with reactive airways. I always questioned the dx as inhalers never helped the winded feeling and feeling that I couldn't get a good breath. Now I suspect those symptoms may have been caused by pericarditis I had never developed a large effusion before. Could chronic pericarditis become worse over time? What happens if we don't discover the underlying cause for the chronic pericarditis ?

Hi Amy,

I believe a cause and effective treatment will be found. However, if the pericardial effusion keeps recurring, your pericardium can be resected. This will remove the source of these effusions.

Hope this helps,

Dr T

Hi Amy,

If indeed caused by an autoimmune disorder, the pericardial effusion will contiunue to form, impair the return of blood back into your heart and cause these symptoms of shortness of breath. This is called cardiac tamponade. One temporizing decompression treatment that will have a longer lasting result includes creating a 'window" to your pleural spaces where your lungs are located in separate compartments. This allows this fluid to drain to a much larger space and relieve the pressure on your heart. However, the resulting Pleural Effusion will need to be drained as well until the cause is determined and treated.

Hope this helps,

Dr T

 

 

Thank you for your response. My ent referred me to an ENT at a major teaching hospital. He feel that there is an underlying Autoimmune dysregulization. I was sent to both a rheumatologist and immunologist. I have had an insane amount of blood work done. Everything is normal except for many markers of inflammation. The fluid was sent to a lab for testing. Today, I again became more winded. Another echo was done and compared to the Echo from when I was discharged from the hospital Saturday. Fluid has started to form. I will have another echo Wednesday or if I continue to have increasing symptoms the echo will be tomorrow. I am so frustrated. The doctors all agree that my inflammatory markers are high but so far points to nothing specific .

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