الفهرس 
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Abstract
The pericardium can be affected by a wide of disease-causing agents and process ranging from viral and bacterial infections and infections with other micro-organism to invasion by neoplastic disease. Clinical manifestations of these different etiologies can be classified into 3 basic types (clinical manifeststions). The first type corresponds to symptoms derived from pericardial inflammation that essentially present as pericardial pain and fever. The second type corresponds to symptoms due to pericardial effusion which in most severe form, may lead to cardiac tamponade. The third type corresponds to symptoms due to thickening, retraction and calcification of the pericardium, indicative of constrictive pericarditis. In the past, chest radiography was used for the initial evaluation of pericardial disease. Plain film chest radiography, however, is neither sensitive nor specific compared with other imaging modalities and detects pericardial disease only in advanced stages. Acute pericarditis is a disorder characterised by acute inflammation of the pericardium and is associated with chest pain, a friction rub and characteristic electrocardiographic changes. The natural history of acute pericarditis is commonly benign and, therefore, management is largely supportive. Recurrent pericarditis is generally manifested by recurrence of acute pericarditis symptoms after resolution and elimination of the inciting agent, usually within 18 to 20 months after the initial episode, but may occur after longer periods. The diagnosis of viral pericarditis is not possible without the evaluation of pericardial effusion and/or pericardial/epicardial tissue, preferably by PCR. A four-fold rise in serum antibody levels is suggestive but not diagnostic for viral pericarditis. The disease appears as an acute, fulminant infectious illness with short duration. Percutaneous pericardiocentesis must be promptly performed. Obtained pericardial fluid should undergo urgent Gram, acid-fast and fungal staining, followed by cultures of the pericardial and body fluids. Chronic (>3 months) pericarditis includes effusive (inflammatory or hydropericardium in heart failure), adhesive, and constrictive forms Tuberculous pericarditis is caused by Mycobacterium tuberculosis. A pericardial effusion is present when there is increased fluid within the pericardial space. This fluid can be serous, serosanguinous, pus, lymph or blood. The management of small or moderate pericardial effusions, without tamponade, is usually conservative, with clinical and echocardiographic surveillance. If the pericardial effusion is likely to be purulent then it should be drained. Knives, bullets, needles, and intracardiac instrumentation are the most common causes of penetrating trauma to the pericardium. In dissection of the ascending aorta (pericardial effusion can be found in 17–45% of the patients and in 48% of the autopsy cases. Pericardial effusion occurs in 5–30% of patients with hypothyroidism. Many pregnant women develop a minimal to moderate clinically silent hydropericardium by the third trimester. Cardiac compression is rare. Constrictive pericarditis (CP) is defined as impedance to diastolic filling caused by a nonelastic, thickened, fibrotic, often calcified, pericardium, usually involves the parietal pericardial layer but can frequently affect the visceral layer also. Normal pericardial thickness does not exclude constrictive pericarditis, for an inelastic fibrous visceral epicardium can physiologically constrict without demonstrable increase in thickness. Effusive–constrictive pericarditis is a form of subacute constriction characterized by effusion into a free pericardial space associated with constriction of the visceral pericardium.