Etiology and prognostic implications of a large pericardial effusion in men

Abstract

Summary:To assess the etiology and prognosis of a large pericardial effusion, we reviewed 25 consecutive patients who presented with a large pericardial effusion and underwent a drainage procedure. Large pericardial effusion was defined as: (1) an echo-free space 2 10 mm anteriorly and posteriorly by M-mode echocardiography and (2) removal of 1 350 ml of fluid at pencardial drainage. The etiologies of large pericardial effusion were: neoplastic (36%), idiopathic (32 %), uremic (20%), postmyocardial infarction (8%), and acute rheumatic fever (4%). Of our patients, 44% presented with cardiac tamponade, while 25% of patients with idiopathic pericarditis had hemorrhagic effusion and cardiac tamponade. At follow-up, 37 f 17 months after pericardial drainage, 68% had died from complications of their underlying disease. There were no deaths attributed to pericardial disease. While 88 % of patients with idiopathic large pericardial effusion were alive at follow-up, none of the neoplastic large pericardial effusion patients survived longer than 5 months after initial pericardial drainage (p < 0.001). Additionally, the survival of patients with uremic large pericardial effusion was better than patients with neoplastic large pericardial effusion (p < 0.05). We conclude: (1) neoplastic, idiopathic, and uremic pericarditis are the most common causes of large pericardial effusion in men, (2) idiopathic pericarditis can be hemorrhagic and cause cardiac tamponade, and (3) the prognosis of large pericardial effusion is related to patients' underlying disease.

Contemporary evaluation of the causes of cardiac tamponade: Acute and long-term outcomes

“…This finding contrasts with previous clinical studies, which reported malignant diseases as the most common cause of pericardial tamponade, reaching 30-60% of cases [6][7][8][9][10][11]. This shift in tamponade etiology is apparently due to the increase in recent years in the overall number and in the complexity of percutaneous intra-cardiac procedures, as well as the introduction of interventional techniques such as trans-catheter valve replacement and catheter ablation for atrial fibrillation, all reported to be possibly complicated by cardiac tamponade [12][13][14][15].…”

A Curious Case of Pericardiohydroptysis

“…In two series on large pericardial effusions tamponade was reported in 44% and 37% of patients respectively. There were no cases of pericardial rupture as a complication reported in them, the mechanism by which our patient's pericardium appears to have decompressed [2,3].…”

“…Aggressive work-up including pericardial biopsy failed to reveal a specific etiology. The patient recovered with conser- Four major studies [2][3][4][5] have addressed the investigation of large pericardial effusions of unknown etiology. In the largest of these studies, 37% of patients with moderate and severe effusion had cardiac tamponade.…”

“…Most patients never reach the hospital, and those who do often have severe associated injuries [2]. A pericardial rupture should be suspected in a patient with severe blunt trauma to the chest [7].…”

Early diagnosis in an unusual presentation of tubercular pericarditis-A case report

“…Being a disease of protean manifestation, it poses a diagnostic dilemma to medical practioners even in endemic areas where clinical suspicion is high [1][2][3][4] . In many patients, an exclusive workup fails to identify the etiological agent.…”