Composition of Pericardial Fluid in Cholesterol Pericarditis

Abstract

Two cases of cholesterol pericarditis have been described. The cholesterol content of the pericardial fluid was in one case 798 and in the other 138 mg/100 ml, but the triglyceride content was very low. Lipid electrophoresis of the pericardial fluid, although it differed from that of the serum, gave inconsistent results. Protein electrophoresis gave similar results in the serum and the pericardial fluid, and the electrolytes were similar in pericardial fluid and serum. Of the enzymes studied, only the lactate dehydrogenase activity (LDH) showed elevated values in the pericardial fluid, with a preponderance of LDH5 isoenzyme.

Heart of Gold: A Scintillating Pericardial Effusion

“…Fluid studies are consistent with an exudative process, a macrophagic predominant cell count with occasional foam cells, and a cholesterol concentration that usually exceeds that of serum. 3 Our patient’s case uniquely illustrates how cholesterol crystallization can occur even in the absence of highly elevated levels in the pericardial fluid.…”

“…Because cholesterol crystallization requires a long incubation period, these effusions often present after they have become very large, as in the current case. The most comprehensive case series is from 1966, 2 which, together with subsequent smaller studies, [3][4][5] establishes rheumatoid arthritis, tuberculosis, and hypothyroidism as causes, although most cases remain idiopathic. Given that little known about this disease, it is important to frame the differential diagnosis around not only the reported asso-ciations of cholesterol pericarditis but also other causes of chronic exudative effusions, as discussed previously.…”