Can tuberculous pleurisy cause pericardial effusion?

Written by Yuan Qing
Pulmonology
Updated on January 21, 2025
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Tuberculous pleurisy can also cause pericardial effusion. Firstly, tuberculous pleurisy is actually caused by the tubercle bacillus, a type of immune response in the human body that manifests as inflammation in the serous cavity. The serous cavities include various types such as the pleura surrounding the lungs, the pericardium around the heart, and the peritoneum in the abdomen. Therefore, tuberculous inflammation can occur in multiple serous cavities, including the pleura, pericardium, and abdominal cavity. Of course, when diagnosing, one cannot solely rely on the presence of effusion in multiple serous cavities to diagnose tuberculous pleurisy. Instead, it is essential to aspirate the pleural fluid and test certain markers in it, such as adenosine deaminase and lactate dehydrogenase. Most importantly, the presence of acid-fast bacilli in the fluid should be checked. If detected, it can generally be diagnosed as tuberculous.

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Written by Chen Tian Hua
Cardiology
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How is pericardial effusion treated?

The treatment of pericardial effusion mainly includes the following measures: First, treatment should be based on the different causes of pericardial effusion. For example, pericardial effusion caused by infection should be treated with anti-infection measures, and pericardial effusion caused by heart failure should be treated with anti-heart failure measures; Second, for a large amount of pericardial effusion or pericardial effusion causing cardiac tamponade, active pericardiocentesis and drainage should be provided to relieve the pressure on the heart caused by the pericardial effusion; Third, when severe pericardial effusion causes hypotension or even shock, volume expansion and pressor agents should also be administered; Fourth, for some patients with pericardial effusion, if the absorption of the effusion is not effective after general treatment, corticosteroids may be appropriately administered.

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Written by Li Hai Wen
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The causes of reduced urine output due to pericardial effusion

Pericardial effusion can potentially lead to reduced urine output. This occurs because in patients with pericardial effusion, the diastolic function of the heart is restricted, limiting the blood volume during the diastolic phase. This, in turn, reduces the amount of blood pumped by the heart during the systolic phase, ultimately leading to ischemia. To ensure the blood supply to vital organs like the brain, the heart reduces its blood supply, impacting the glomerular filtration rate, and thus symptoms of reduced urine output can occur. Additionally, symptoms such as limb edema, shortness of breath, respiratory difficulties, and chest tightness often accompany these. As pericardial effusion can cause congestion in the gastrointestinal tract, some patients may also experience abdominal distension, nausea, and vomiting among other digestive symptoms. A pericardial effusion ultrasound can definitively diagnose a pericardial effusion.

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Written by Di Zhi Yong
Cardiology
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When should the pericardial effusion drainage tube be removed?

If the patient has pericardial effusion and there is no apparent leakage from the drainage tube, and no fluid drainage, it is possible to consider removing the tube after two days. In cases like this, active drainage is sometimes still necessary because pericardial effusion is a type of exudate, which can be inflammatory. Draining can help relieve the cardiac workload. If the drainage tube is clear and there is no fluid leakage, removing the tube after about two days can be considered. However, there is a situation where the tube must not be removed. If there is fluid leaking from the pericardial effusion, or if the symptoms of pericardial effusion are still severe, and there is some fluid remaining in the pericardial cavity, the tube should not be removed.

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Written by Di Zhi Yong
Cardiology
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What will happen if there is too much pericardial effusion?

If a patient has an excessive amount of pericardial effusion, symptoms such as palpitations, chest tightness, and difficulty breathing can occur. Currently, the treatment primarily focuses on symptomatic relief. If there is excessive pericardial effusion, symptoms such as chest tightness, palpitations, and difficulty breathing may occur. I personally suggest going to the hospital for a cardiac echocardiogram to further confirm the diagnosis and determine the treatment plan. For simple pericardial effusion, if the amount is relatively small, it can be temporarily observed without treatment. However, for cases with excessive pericardial effusion, it is necessary to perform a pericardiocentesis to remove the fluid and improve cardiac function. During this period, it is still necessary to actively monitor the patient's blood pressure, heart rate, and pulse changes, and address any rapid heart rate.

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Will pericardial effusion cause an increase in troponin levels?

In general, if a patient is diagnosed with pericardial effusion, troponin levels might also increase under stress conditions. This is because troponin is primarily used as a marker to assess myocardial infarction. An increase in troponin levels suggests the possibility of a myocardial infarction. However, under stress conditions, especially with pericardial effusion, troponin levels can rise. During this period, it is also advisable to perform an electrocardiogram or a cardiac echocardiography on the patient for a more definitive diagnosis. A mere increase in troponin levels does not conclusively indicate a problem; it is necessary to consider the patient’s current symptoms and results from other diagnostic tests.