[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Heart](https://durgical.com/en/general-pathology/areas/heart/) › Pericardial disease

# Pericardial disease

- Lesion

Fluid, blood or inflammation can fill or stiffen the sac around the heart. Fast-filling fluid squeezes the heart; old scar can trap it.

Updated Nov 12, 2026

## Key points

- Serous effusion: heart failure, hypoalbuminemia, hypothyroidism; serosanguinous: trauma, malignancy; chylous: lymphatic obstruction.
- Haemopericardium: ruptured MI, aortic dissection, trauma; can cause sudden death by tamponade.
- Fibrinous pericarditis: uremia, MI, Dressler syndrome, rheumatic fever, lupus, radiation, viral infection; friction rub.
- Purulent pericarditis: bacterial spread from the lungs or blood; caseous pericarditis: tuberculosis.
- Haemorrhagic pericarditis: tumour or tuberculosis, also after cardiac surgery.
- Constrictive pericarditis: dense fibrous or calcified sac; tuberculosis is a major cause in developing regions, prior surgery and radiation in others.

## What it is

The pericardial sac can fill with fluid (effusion), blood (haemopericardium), pus or tumour, and its layers can become inflamed (pericarditis). The effect depends on how fast fluid accumulates: a slowly growing large effusion may be tolerated, while a small, rapid one (ruptured infarct, dissection, trauma) causes tamponade. Acute pericarditis is classified by its exudate: serous, fibrinous, purulent, haemorrhagic or caseous. Healing can leave adhesions or a thick, rigid shell that restricts filling (constrictive pericarditis).

## Structure

- Fibrinous pericarditis: fibrin strands on both surfaces with neutrophils; organises into adhesions.
- Constrictive pericarditis: obliterated sac, thick fibrous or calcified shell around the heart; myocardium usually small and atrophic.

## Acute pericarditis by its exudate

| Exudate | Typical causes | Appearance |
| --- | --- | --- |
| Serous | Viral infection, autoimmune disease, uremia, tumours nearby | Clear fluid with few inflammatory cells |
| Fibrinous and serofibrinous | Myocardial infarction, Dressler, uremia, rheumatic fever, lupus, radiation | Dull, shaggy ‘bread and butter’ surface |
| Purulent (suppurative) | Bacteria, fungi, parasites | Thick creamy pus, red granular serosa |
| Haemorrhagic | Malignancy, tuberculosis, bacterial infection, after surgery | Blood mixed with fibrinous or purulent exudate |
| [Caseous](https://durgical.com/en/conditions/pulmonary-tuberculosis/) | Tuberculosis (rarely fungi) | Caseating granulomas; often leads to constriction |

## Clinical notes

- Tamponade: hypotension, raised jugular pressure, muffled heart sounds (Beck triad) and pulsus paradoxus.
- Constriction: right-sided failure signs with Kussmaul sign and a pericardial knock; it can be cured by pericardiectomy.

## Memory aid

Speed beats size: a little blood fast can kill, a lot of fluid slowly can be tolerated; and old scar can trap the heart in a shell.

## Test yourself

Think of the answer, then tap the question to see it.

## Why can a small haemopericardium be fatal while a large chronic effusion is tolerated?

Rapid accumulation gives the pericardium no time to stretch, so pressure rises and compresses the heart (tamponade).

## Which type of pericarditis is typical of tuberculosis?

Caseous pericarditis, which often leads to constrictive pericarditis.

## Which pericarditis appears one to three days after a transmural infarct?

A fibrinous (or serofibrinous) pericarditis over the infarcted area.

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[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

- [Cardiac tamponade: Beck triad and pulsus paradoxus](https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/)

## Connections

## Related 6

- [Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer](https://durgical.com/en/general-pathology/patterns-of-acute-inflammation-serous-fibrinous-purulent-abscess-ulcer/)
- [Complications of myocardial infarction](https://durgical.com/en/general-pathology/complications-of-myocardial-infarction/)
- [Restrictive cardiomyopathy and cardiac amyloidosis](https://durgical.com/en/general-pathology/restrictive-cardiomyopathy-and-cardiac-amyloidosis/)
- [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/)
- [Aortic dissection](https://durgical.com/en/general-pathology/aortic-dissection/)
- [Pleural effusion and pneumothorax](https://durgical.com/en/general-pathology/pleural-effusion-and-pneumothorax/)

## Related conditions 8

- [Acute pericarditis](https://durgical.com/en/conditions/acute-pericarditis/)
- [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/)
- [Constrictive pericarditis](https://durgical.com/en/conditions/constrictive-pericarditis/)
- [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)
- [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Mechanical complications of myocardial infarction](https://durgical.com/en/conditions/mechanical-complications-of-myocardial-infarction/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Pericarditis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000182.htm) (MedlinePlus, US National Library of Medicine, 2025); [Cardiac Tamponade](https://www.ncbi.nlm.nih.gov/books/NBK431090/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/pericardial-disease/