Pericardial Disease

The echocardiogram shown above demonstrates a significant anechoic collection surrounding the heart. What is the most likely diagnosis?

A 38-year-old man from Delhi presents with acute onset pleuritic chest pain, fever (38.5°C), and dyspnea for 3 days. He had an upper respiratory tract infection 2 weeks ago. On examination, pericardial friction rub is heard. ECG shows diffuse ST elevation with PR depression in leads II, III, aVF, and V4–V6. Troponin I is mildly elevated (0.08 ng/mL). Echocardiography shows a small pericardial effusion without tamponade. Which is the most likely diagnosis?

A 38-year-old man from rural Maharashtra presents with a 3-week history of progressive dyspnea, orthopnea, and lower limb edema. On examination, he has elevated JVP with prominent y descent, muffled heart sounds, and hepatomegaly. Chest X-ray shows a large pericardial effusion. Echocardiography reveals diastolic collapse of the right atrium and right ventricle with respiratory variation in mitral inflow velocities. Pericardial fluid analysis shows lymphocytic predominance with adenosine deaminase (ADA) level of 18 U/L. What is the most likely diagnosis?

A 52-year-old woman with a history of breast cancer (treated with anthracycline chemotherapy 5 years ago) presents with progressive dyspnea, orthopnea, and peripheral edema over 2 months. On examination, she has elevated JVP, quiet heart sounds, and hepatomegaly. Chest X-ray shows a large pericardial effusion with a thickened pericardium. Echocardiography demonstrates diastolic collapse of the right ventricle lasting >1/3 of diastole, and Doppler shows >25% respiratory variation in mitral inflow velocity. Cardiac catheterization reveals equalization of diastolic pressures with a prominent y descent. Pericardial biopsy shows fibrous tissue with chronic inflammation but no malignant cells. What is the most appropriate next step in management?

A 52-year-old woman with a 2-year history of systemic lupus erythematosus presents with progressive dyspnea, orthopnea, and lower limb edema over 3 weeks. Blood pressure is 145/92 mmHg, JVP is elevated at 8 cm H₂O, and there is hepatomegaly. Echocardiography shows a large circumferential pericardial effusion (4.5 cm) with early diastolic right atrial collapse. Pericardial fluid analysis is exudative with ANA positivity. Which is the most appropriate next step in management?