Pericardial Effusions: Causes, Diagnosis, and Management

Vakamudi, Sneha; Ho, Natalie; Cremer, Paul

doi:10.1016/j.pcad.2016.12.009

Cited by 143 publications

(119 citation statements)

References 37 publications

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“…Secondary malignancies were the most common cause of MAL PE. Lung cancer (11/30, including 8 lung adenocarcinomas, 2 small cell lung cancer, and 1 squamous cell carcinoma) followed by breast cancer and hematopoietic malignancies were the most common causes of malignant PE in our study, which is similar to a previous study [16], while breast cancer was reported as the most common primary site in other prior published studies [16, 20]. Lung adenocarcinoma was the most common type of lung cancer involving PF in our study, while small cell lung cancer was reported to be the most common type of lung cancer in other studies [16].…”

Section: Discussionsupporting

confidence: 91%

Application of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) on Reporting Pericardial Effusion Cytology

et al. 2020

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Introduction: The International System for Reporting Serous Fluid Cytopathology (ISRSFC) has recently been announced. Pericardial effusion (PE) is a clinical manifestation of a large variety of both neoplastic and non-neoplastic conditions. Herein, we have applied the ISRSFC on reporting PE cytopathology and report our experience in a large academic institution. Method and Materials: After the Institutional Research Board approval, the electronic pathology database of a large academic institution was queried for PEs collected from January 2014 to January 2019. The diagnosis, patient demographics, and specimen volume were recorded for each case. The ISRSFC was applied and the cases were divided into 5 categories: nondiagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). Each category was evaluated separately. Results: A total of 299 cases were identified, 162 females and 137 males. The age of the subjects ranged from less than a year to 89 years (average 51.25 years). The volume ranged from 3 to 1,700 mL (average 298 mL). There were 252 NFM (84.3%), 13 AUS (4.3%), 4 SFM (1.3%), and 30 MAL (10%) cases. Metastatic lung cancer followed by metastatic breast cancer were the most common malignancies involving pericardial fluid (PF). No cases were diagnosed as ND. However, no mesothelial cells were seen in 97 specimens (38% of the negative cases). None of these patients developed malignant PE in at least 6 months of follow-up. Conclusion: The ISRSFC is a user-friendly reporting system which is easily applicable on serous fluid including PF. The vast majority of PEs was benign (84.3%). Our study shows that the presence of mesothelial cells is not necessary for specimen adequacy in serous effusions as no mesothelial cells were identified in 38% of the negative cases. Metastatic lung carcinoma was the most common diagnosis of malignant effusions.

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Section: Discussionsupporting

confidence: 91%

Application of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) on Reporting Pericardial Effusion Cytology

et al. 2020

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“…While tuberculosis is the most common etiology of pericardial effusion in developing countries, idiopathic pericarditis, often viral in origin, is a most common cause of inflammation-related pericardial effusion in developed countries such as the United States. [ 6 ] Viral pericarditis typically has a benign course and can be treated with medications…”

Section: Discussionmentioning

confidence: 99%

“…With regards to treatment, high dose NSAIDs are the first-choice therapy for acute pericarditis with secondary alternatives being colchicine and lastly glucocorticoids. [ 6 , 9 ] There were concerns that the use of NSAIDs and glucocorticoids in patients with COVID-19 would worsen the disease but the Center for Disease Control states that NSAIDs and glucocorticoids can be used when clinically indicated. [ 10 – 12 ] In accordance with the above recommendation, we opted to discharge our patients with high dose NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection

et al. 2020

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Rationale: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. Patient concerns: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. Diagnosis: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. Interventions: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. Outcomes: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. Lessons: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.

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“…With the widespread application of cardiovascular imaging approaches, pericardial effusion is being increasingly recognized (1). Among the potential reasons for pericardial effusion, tuberculous pericarditis is one of the more frequent aetiologies, especially in developing countries (2).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis

Liu¹,

Cui²,

Ding³

et al. 2018

J. Thorac. Dis.

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Pericardial Effusions: Causes, Diagnosis, and Management

Cited by 143 publications

References 37 publications

Application of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) on Reporting Pericardial Effusion Cytology

Application of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) on Reporting Pericardial Effusion Cytology

Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection

Diagnostic accuracy of interferon-gamma in pericardial effusions for tuberculous pericarditis: a meta-analysis

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