A surgical approach using a “pericardial window” is performed when there is concern that the pericardial fluid will accumulate, such as with a malignant pericardial effusion.

This is usually done percutaneously through a subxiphoid approach. A surgical pericardial window can be done to create communication between the pericardial space and the pleural space.

On the contrary, if tuberculosis is endemic in the population, empirical anti-tuberculosis therapy is considered for the treatment of pericardial effusions when other causes have been excluded.