Pericardial effusion in children is caused by bacterial and viral infections, connective tissue disease, metabolic disorders and malignancies. Pericardial effusion have a broad range of clinical manifestations. Acute tamponade is the most serious form of presentation, for which treatment clearly needs to be rapid and effective. Pericardial drainage can be achieved either by percutaneous catheter drainage or by surgery. When tamponade is not present, time is available to perform appropriate investigations and arrange definitive treatment. Echocardiography is an accurate and sensitive, bedside, non-invasive diagnostic tool. We report our experience of pericardial effusions in childhood.

We were retrospectively analyzed records of children admitted in pediatric cardiology unit with pericardial effusion from January 2005 to December 2013. The medical records of all patients with effusions were reviewed to determine etiology, management, and outcomes.

Eighty-three children (47 male and 36 female) were diagnosed to have pericardial effusion during study period. The age range was 1 week to 19 years (median 9 years). The measured size of the pericardial effusion in right ventricle anterior wall ranged from 2 to 40 mm (median 14.4), in left ventricle posterior wall ranged from 3 to 66 mm (median 15.2), in apex nged from 2 to 40 mm (median 10). Eighteen patients (21.7%) had postsurgical pericardial effusion, 16 patients (19.3%) had an underlying neoplastic disorder; 9 patients (10.8%) had associated collagen vascular disease; and 4 patients (4.8%) had an underlying diagnosis of renal disease. Three patients (3.6%) were premature infants and had percutaneous long lines. One patients (1.2%) was infected with tuberculosis and three patients (3.6%) had other diagnoses (one each with hypothyroidism, acute rheumatic fever, and dilate cardiomyopathy). Twenty-nine patients (34.9%) had no identified etiology and were designated as having idiopathic disease. Echocardiography and/or fluoroscopy guided pericardiocentesis was done in 25 patients. Open surgical drainage in 8 (9.6%); 6 patients (7.2%) underwent initial percutaneous followed by surgical drainage.

A wide variety of conditions may result in pericardial effusion. All types of acute pericarditis (inflammatory, infectious, immunologic or of physical origin) can be associated with pericardial effusion. When cardiac tamponade is suspected echocardiography-guided pericardiocentesis has a well-established therapeutic role.