Pericardial effusions: do they all require pericardiocentesis?

Pericardial effusions are associated with multiple disorders, the causes of which are dependent on local epidemiologic and patient-specific factors. Pericardial effusions exhibit a broad spectrum of clinical presentations and may or may not be symptomatic. Echocardiographically guided pericardiocentesis should be reserved for patients with hemodynamic compromise, an intrathoracic mass effect, or an uncertain cause. Not all patients with pericardial effusions require pericardiocentesis, and an algorithmic approach to the decision to perform pericardiocentesis is recommended.