Pericarditis- types & morphology

Jawariya Zia Roll no. 56

Pericarditis

• Pericardial inflammation

Causes

• Infectious agents:VirusesPyogenic bacteriaTuberculosisFungiParasites

• Immune mediatedRheumatic feverSystemic lupus erythematosisSclerodermaDrug hypersensitivity reactionPostmyocardial infarction (Dressler)

syndrome

• OthersMyocardial infarctionUremiaAfter cardiac surgeryNeoplasiaTraumaRadiation

Types

• Acute• Chronic

Acute Pericarditis

SerousFibrinous & serofibrinousHemorrhagicPurulent/ suppurativeCaseous

Serous pericarditis

• Mild inflammation with sterile serous effusion

Causes • noninfectious inflammatory diseases such

as rheumatic fever, SLE, tumors, uremia • infections contagious to the pericardium

(upper respiratory tract infection, pneumonia)

• Viral pericarditis accompanied with myocarditis in young children

Fibrinous & Serofibrinous

• Most frequent type• Serous fluid + fibrinous exudate• Causes: acute MI, Dressler syndrome, uremia,

rheumatic fever, SLE

Hemorrhagic pericarditis

• Exudate composed of blood mixed with fibrinous or suppurative effusion usually containing neoplastic cells

• Bacterial infections• Bleeding disorders• Cardiac surgery

Purulent/ Suppurative Pericarditis

• Invasion of pericardial space by microbes from• neighboring infections; e.g. empyema, lobar

pneumonia, mediastinal infections • seeding from the blood• Lymphatic extension• Direct introduction during cardiotomy

• Exudate may range from a thin cloudy fluid to frank pus upto 400-500mL in volume

Caseous pericarditis

• Rare • Tuberculosis• Fungal infections• Frequently causes chronic constrictive

pericarditis

Chronic Pericarditis

Adherent mediastinopericarditis Constrictive pericarditis

Adherent mediastinopericarditis

• Pericardial sac obliterated, adherence to mediastinal structures

• Great strain on the heart specially during systole

Constrictive pericarditis

• dense fibrous or fibrocalcific shell that limits cardiac function

• 0.5- 1.0 cm thick• Sometimes calcifies• Concretio cordis-extreme cases of hardening• Functions of the heart are restricted,limits

diastolic expansion & cannot respond to increased peripheral needs

au revoir :)