Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?

Mercé, Jordi; Sagristà-Sauleda, Jaume; Permanyer-Miralda, Gaietà; Soler‐Soler, Jordi

doi:10.1016/s0002-9343(98)00192-2

Cited by 123 publications

(54 citation statements)

References 7 publications

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“…Pericardial aspiration is not indicated as a routine investigation, because of the low diagnostic yield, 15 although, in addition to cardiac tamponade, a clinical suspicion of purulent pericarditis is an indication for pericardiocentesis. Percutaneous pericardiocentesis was associated with initial relief of symptoms in almost all cases, and when the drain was left in situ for 48 hours the recurrence rate was generally low, although leaving the drain in situ increases the risk of subsequent infection.…”

Section: Discussionmentioning

confidence: 99%

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

et al. 2000

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The aim of the study was to determine the aetiology of large and symptomatic pericardial eVusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial eVusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of AfroCaribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an eVective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low. (Postgrad Med J 2000;76:809-813)

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Section: Discussionmentioning

confidence: 99%

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

et al. 2000

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“…1 -3 However, diagnostic pericardiocentesis should be decided very carefully due to low diagnostic yield. 4 In patients with cardiac tamponade, echocardiography is the main method for diagnosis and treatment. Sufficient cardiac decompression can be achieved by echo-guided pericardiocentesis with extended drainage.…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Large, Symptomatic Pericardial Effusion Treated by Echo‐guided Percutaneous Pericardiocentesis

Kil

Jung

Koh

et al. 2008

Clinical Cardiology

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Backgrounds:The causes and prognosis of pericardial effusion (PE) may be different according to time, region, economy, and hospital. This study was performed to evaluate the etiology, clinical outcome, and prognosis of patients with large, symptomatic PE treated by echo-guided pericardiocentesis at Kangnam St. Mary's Hopital (the Catholic University of Korea, Seoul, Korea). Hypothesis: According to etiologies of large, symptomatic PE, the prognosis of patients may be different. Methods: We reviewed 116 consecutive patients who underwent echo-guided pericardiocentesis due to large, symptomatic PE over the last 12 y. The Kaplan-Meier survival curve with log-rank method was applied for the survival analysis.Results: Procedural success rate of echo-guided pericardiocentesis was 99.1%. Common causes of PE requiring pericardiocentesis were lung cancer (27.6%), tuberculosis (TB) (13.8%), and uremia (6.9%). The mortality rate of 6 mo after the pericardiocentesis was 80.3% in malignant PE, whereas the over-all mortality rate was 18.2% in nonmalignant PE (p<0.0001). Among the malignant PE, lung cancer (27.6%) and breast cancers (6.9%) were the most common causes. The mean cytologic detection rate and mean life expectancy of malignant PE were 44% and 5-7 mo. Patients with breast cancer and lymphoma had relatively better life expectancy (11.4 and 7.7 mo), whereas those with stomach cancer and metastases of unknown origin (MUO) had poorer prognosis (1.2 and 2.3 mo). The most common causes of nonmalignant PE were TB, uremia, and iatrogenic, and their mean life expectancy was approximately 54 mo. Conclusions: Malignancy, especially lung cancer and TB, were the most common causes of large symptomatic PE. The prognosis of large symptomatic PE was related to the underlying disease. Malignant PE was associated with the poorest prognosis.

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“…Large pericardial effusions are most common with tumors, tuberculosis pericarditis, cholesterol pericarditis, myxedema, vasculitis/connective tissue disease, uremic pericarditis, and parasitoses. 25 An effusion is often asymptomatic but should be suspected in the appropriate clinical setting. Pericardial effusions can present with vague chest symptoms such as a feeling of chest pressure and chest ache.…”

Section: Faculty Discussionmentioning

confidence: 99%

Clinicopathological Conference: Fever, Productive Cough, and Tachycardia in a 22‐year‐old Asian Male

Singh

Moayedi

2004

Academic Emergency Medicine

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Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?

Cited by 123 publications

References 7 publications

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

Prognosis of Large, Symptomatic Pericardial Effusion Treated by Echo‐guided Percutaneous Pericardiocentesis

Clinicopathological Conference: Fever, Productive Cough, and Tachycardia in a 22‐year‐old Asian Male

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