Etiologic Diagnosis of 204 Pericardial Effusions

Abstract

The etiologic evaluation of pericardial effusion is frequently unsuccessful when noninvasive methods are used. To determine the cause of the current episode, all patients with echographically identified pericardial effusion from May 1998 to December 2002 underwent noninvasive diagnostic testing of blood, throat, and stool samples. Patients with postpericardiotomy syndrome were excluded. To analyze the value of our tests, we tested randomly selected blood donors as negative controls. Among 204 included patients, 107 (52.4%) had a final etiologic diagnosis: the etiology of 52 was highly suspected at first examination and later confirmed (thyroid deficiency, 5 cases; systemic lupus erythematous, 7; rheumatoid arthritis, 7; scleroderma, 3; cancer, 25; and renal insufficiency, 5). A definite etiologic diagnosis was made in 11 patients from pericardial fluid analysis (cancer, 5 cases; tuberculosis, 3; Streptococcus pneumoniae, Citrobacter freundii, and Actinomyces, 1 case each). Among 141 patients considered to have idiopathic pericarditis, 44 (32.1%) gained an etiologic diagnosis by our systematic testing strategy. This included serologic evaluation of serum (Coxiella burnetii, 10 cases; Bartonella quintana, 1; Legionella pneumophila, 1; Mycoplasma pneumoniae, 4; influenza virus, 1), viral culture of throat swabs (enterovirus, 8 cases; and adenovirus, 1), high-level antinuclear antibodies (>1/400, 3 cases), and thyroid-stimulating hormone (15 abnormal results). Antibodies to Toxoplasma and cytomegalovirus, enterovirus recovered from rectal swabs, and low-level antinuclear antibodies were seen with equal frequency in patients and controls. Using our evaluation strategy, the number of pericardial effusions classified as idiopathic was less than in other series. Systematic testing for Q fever, Mycoplasma pneumoniae, thyroid abnormalities, and antinuclear antibodies, accompanied by viral throat cultures, frequently enabled us to diagnose diseases not initially suspected in patients with pericardial effusion.

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

“…W okresie ostatnich 20 lat opublikowano 5 głównych doniesień na temat konsekwencji gromadzenia się umiarkowanych lub dużych ilości płynu w worku osierdziowym (dodatkowa tab. 3) [74][75][76][77][78]. U wielu chorych obecność płynu w worku osierdziowym nie wiąże się z występowaniem żadnych objawów klinicznych, a zaburzenie to wykrywane jest przypadkowo w przeglądowym badaniu radiologicznym klatki piersiowej lub podczas badania echokardiograficznego wykonanego z innych wskazań.…”

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

“…In the past 2 decades, only 5 sizeable prospective series on the etiology of pericardial effusions have been reported. Two of those series included distinct populations in which tuberculosis and human immunodeficiency virus (HIV) are common, and thus the participants are not necessarily representative of other cohorts 11, 12, 13, 14, 15…”

Isolation of Candidatus Bartonella melophagi from Human Blood1

“…berkhoffi i (2,12). Pericardial or pleural effusions are infrequent complications of B. henselae infection in association with classical cat-scratch disease (13,14).…”