Pathology of the Parietal Pericardium: A Consensus Statement on Pericardial Disease from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology

BACKGROUND AND AIM: Pericardial diseases encompass a broad spectrum of infectious, inflammatory, metabolic, traumatic, iatrogenic, and neoplastic disorders occurring in the setting of both localized and systemic conditions. Advances in understanding of the pathogenesis and diagnosis of pericardial disease have been substantial. Despite extensive literature on the clinical aspects of pericardial disease, relatively few studies have focused on its pathologic features. METHODS AND RESULTS: An international panel from volunteer members of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology conducted a comprehensive review of the literature to develop a consensus document on the recommendations for pathologic evaluation of the parietal pericardium. This first document summarizes our state-of-the-art understanding of the etiological and morphological aspects of pericardial diseases, including pericardial effusions, cardiac tamponade, infectious and non-infectious pericarditis, and constrictive pericarditis, and incorporates updated clinical definitions and diagnostic criteria. CONCLUSION: This consensus review highlights the role of pathology in the diagnosis of pericardial disease. Future efforts should explore establishing contemporary reference ranges for normal pericardial fluid volume, refining the pathologic characterization of pericarditis, correlating histopathologic findings with advanced cardiac imaging, and elucidating the molecular mechanisms driving the progression of pericardial fibrosis to constrictive disease.