Chronic Effusive Pericarditis

Chronic idiopathic pericardial effusion.

“…The features of chronic large pericardial effusions have been reviewed by Bedford (1964), and a comprehensive bibliography has been published in his paper. Congestive heart failure is a common mode of presentation, but cases with a prolonged course and few symptoms have been described frequently.…”

Chronic Idiopathic Pericardial Effusion

“…Impaired pericardial absorption may result from damage to the pericardium caused by rheumatic fever (Winters and Soloff, 1961), and Camp and White (1932), in a necropsy study of patients dying in congestive cardiac failure, noted a raised incidence of pericardial effusion in patients with rheumatic heart disease compared with patients with other cardiac disorders. It is interesting that one of the present patients (Case 2) gave a history of chorea in childhood, and other authors have reported patients with chronic idiopathic pericardial effusion and a preceding history of chorea (Connolly et al, 1959), "migratory arthritis" (Storey et al, 1960), and rheumatic fever (Bedford, 1964). Thus the sequence of events in some chronic effusions of unknown aetiology may be:…”

“…Spodick (1964) has suggested that intrapericardial bleeding is the common denominator in cholesterol-rich effusions, but it is not necessary to postulate pericardial hemorrhage as the cause of the lipid composition of the fluid in Case 2. Bedford (1964) has suggested that auto-immune pathology may be involved in the pathogenesis of chronic effusive pericarditis. Positive antinuclear factor tests were found in 3 of his 7 cases, one of which had scleroderma; and Szatkowski and Inoue (1963) have reported a case of "cholesterol pericarditis" with an abnormal latex test for rheumatoid arthritis, though they considered tuberculosis to be the cause of the effusion despite negative smears and cultures of the fluid from the pericardial and pleural cavities.…”

“…Cardiac catheterization and angiocardiography may be hazardous when the alternative diagnosis is severe cardiac failure, and the wider use of the radioactive scanning technique seems justifiable in patients with unexplained enlargement of the heart shadow on x-ray examination. Bedford (1964) has summarized the causes of chronic pericardial effusion. Neither of the present cases was anaemic and careful clinical and laboratory investigation failed to reveal any evidence of scleroderma or systemic lupus erythematosus.…”

“…Wood (1956) has drawn attention to 6 cases associated with hypertension and Bedford (1964) has reported 7 with 'chronic effusive pericarditis'. Similar instances, in which the pericardial fluid has contained numerous cholesterol crystals, have been described recently by Griffin and Swan (1963) and Livesley and Jack (1965).…”