57 Pericardial Diseases in Children Saurabh K Gupta Abstract The pericardium is afflicted in a variety of diseases, both localized to the heart and as part of systemic illnesses Pericardial diseases cause distinctive hemodynamic changes and some of the classic physical findings in cardiology Although clinical overlap is common, most of the cases can be categorized as having pericarditis, pericardial effusion with or without tamponade, and pericardial constriction Other structural abnormalities such as congenital absence of pericardium and pericardial cysts are rare This chapter provides an overview of common pericardial diseases in children Keywords Pericardium; pericarditis; recurrent pericarditis; pericardial effusion; bacterial pericarditis; tubercular pericarditis; pericardial constriction; ventricular interdependence; ventricular discordance; pulsus paradoxus; pericardiectomy The pericardium derives its name from the Greek term peri, meaning “around,” and kardia, meaning “heart.” It is composed of two layers The inner layer (visceral pericardium) consists of a single layer of mesothelial cells, collagen, and elastin fibers separated from epicardium by fat The outer layer (parietal pericardium) is mostly acellular and consists of collagen and elastin fibers The pericardial space between these two layers contains a small amount of serous fluid The pericardium surrounds all the cardiac chambers except the left atrium, which is extrapericardial Superiorly, the fibrous envelope extends to the base of great vessels.1–4 Although not essential for survival, the pericardium has some important functions It acts as a barrier to prevent spread of infections, inflammation, and neoplasia The fluid in the pericardial space allows free movement of the heart throughout the cardiac cycle, limits its acute distension, and helps in ventricular coupling.2 The parietal layer imparts characteristic physical properties to the pericardium At low level of stretch, it is very elastic but as the stretch increases, the tissue stiffens abruptly and become resistant to further stretch.3 As a result, the pericardium exhibits a nonlinear pressure-volume curve with an initial flat portion and a steep ascent later (Fig 57.1) ... Pericardial diseases cause distinctive hemodynamic changes and some of the classic physical findings in cardiology Although clinical overlap is common, most of the cases can be categorized as having pericarditis, pericardial effusion with or without