Pleural Effusions and Pericarditis: A Retrospective Cohort Study of Patients Undergoing Cardiac Magnetic Resonance Imaging

Abstract

BackgroundPleural effusions can occur due to acute pericarditis and can necessitate intervention. We sought to add to the evidence base by performing a retrospective review of patients presenting to the advanced cardiac imaging unit with pericarditis and pleural effusion to determine laterality, trends in pleural fluid analyses, and the need for pleural intervention. Local ethical (Caldicott) approval was obtained for this study. MethodologyDescriptive statistical methodology was applied with continuous data presented as mean (standard deviation, SD; range) and categorical variables as frequencies or percentages. ResultsIn 60 patients with pericarditis, 24 (39%) had pleural effusions on contemporaneous imaging. The mean age of the study population was 63.3 years (range: 20-83), and 17 patients were males. Diagnoses were viral (five), rheumatological (one), amyloidosis (one), listeria (one), and the rest idiopathic (17). Four effusions were only left-sided, one right-sided, and 20 bilateral. Ten pleural taps were performed, one for a unilateral effusion and nine for one side being bigger than the other. The mean pH was 7.46 (7.33-7.6), mean lactate dehydrogenase was 210 (74-393 U/L), mean fluid protein was 36.1 (19-56 g/L) (four effusions exudative/three transudative), mean glucose was 5.8 (4.8-6.8 mmol/L), and all cytologies were negative. Five patients underwent large volume aspirations for symptom control. Three indwelling pleural catheters (IPC) were placed for treatment refractory effusions. There was one pleural space infection in six months related to an IPC. There were three deaths at 12 months, with none related to pericarditis. ConclusionsPleural effusions associated with pericarditis are usually small, bilateral, and exudative. Treatment refractory cases require pleural intervention, with aspirations, drains, and IPCs being viable options. Further prospective studies are warranted.

Cardiac related pleural effusions: a narrative review

“…In Western countries, around 55% of cases are idiopathic in nature ( 61 , 62 ). PEs can occur with pericarditis ( 63 ). Due to the anatomical boundaries of the pleural and pericardial surfaces, PEs are thought to develop due to contiguous inflammation in the context of acute pericarditis ( 64 , 65 ).…”

“…More recently, Ahmed et al [2022] analysed a cohort of 60 patients with pericarditis and 24 (39%) had presence of PEs on simultaneous imaging ( 63 ). Twenty PEs were bilateral and four PEs were left sided.…”

“…Typically, patients are treated for their underlying cause (pericarditis) with a combination of ibuprofen, colchicine and steroids for a few weeks (e.g., up to 3 weeks) and the PEs resolve gradually ( 63 ). Based on the current evidence, it is noted that PEs in the context of pericarditis are usually small, bilateral and exudative in nature.…”

A Review of the Complications of Endomyocardial Fibrosis along with Their Physiological Compromise

“…First-degree heart blocks and ventricular tachycardias have also been reported in EMF cases. Ventricular fibrillation, which can arise from ventricular tachycardias, increases the risk of cardiac arrest" [9].…”