Treatment

Goals of Therapy:

1. To quickly control the distensibility abnormality especially if cardiac tamponade is present:
   • Pericardiocentesis
2. To control recurrent episodes of effusions:
   • Repeated pericardiocentesis as pericardial effusion recurs
   • Corticosteroids may retard/prevent recurrence in idiopathic cases (prednisone: 0.5 mg/kg BID (PO))
   • Surgical removal of the pericardial sac

Comments:

• Surgery not only allows for removal of the pericardial sac but also for the determination of an underlying neoplastic process.
• Pericardiocentesis is not a benign procedure. The risk of coronary artery laceration is substantial if done improperly which could result in sudden death. When performed, the procedure should enter the pericardial sac from the right hemithorax. Also an ECG should be performed simultaneously to detect epicardial irritation/contact.
• In contrast to the literature, the author believes the neoplastic etiologies are more common than the idiopathic variety.
• In cases of hemangiosarcoma, metastasis has usually occurred by the time the right auricular mass is detected.