Aetiologies of pericardial effusion among medical patients at Nelson Mandela Academic Hospital, Mthatha, South Africa: A cross-sectional study.

BACKGROUND: Pericardial effusion aetiology varies across geographical locations and epidemiological contexts. In the developing world, tuberculosis (TB), catalysed by human immunodeficiency virus (HIV), is the leading aetiology, while in the developed world, it is idiopathic. The TB epidemic and paucity of recent, regional context aetiological profiling may overshadow other aetiologies in the empirical treatment guidelines. METHODS: A retrospective cross-sectional study of clinical records was conducted to investigate the aetiologies of pericardial effusion in adult patients at Nelson Mandela Academic Hospital (NMAH) in Mthatha, South Africa, between January 2022 and October 2025. RESULTS: A total of 141 patients were included in this study, with females constituting 52.5% and males (47.5%). The most common presentation symptom was dyspnoea (97.9%), followed by fatigue (84.4%). The most common signs on examination were muffled heart sounds (92.2%) and increased jugular venous pressure (JVP) (61.0%). Idiopathic pericardial effusion was the most common aetiology (29.8%), followed closely by TB (29.1%) and malignancy (9.9%). Among HIV-positive patients, TB was the predominant cause (55.6%), followed by HIV-related pericardial effusion (25.9%). In contrast, HIV-negative patients most commonly had idiopathic pericardial effusion (35.1%), followed by TB (22.8%) and malignant causes (11.4%). CONCLUSION: Pericardial effusion in this setting has a heterogeneous aetiological profile and therefore calls for a systematic diagnostic approach to improve aetiological diagnosis and guide appropriate management in high TB and HIV prevalence settings. CONTRIBUTION: The addition to the limited regional data on the aetiologies of pericardial effusion in a resource-limited South African setting will inform appropriate diagnostic prioritisation, empiric management strategies and resource allocation in similar settings.