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Clinical clues to the causes of large pericardial effusions
J Sagristà-Sauleda1, J Mercé, G Permanyer-Miralda
1Servei de Cardiologia, Hospital General Universitari Vall d'Hebrón, Barcelona, Spain.
Insights
Pericardial effusion causes can often be identified by looking at inflammatory signs, effusion size, and cardiac tamponade. These factors help determine the underlying condition in patients with moderate to severe pericardial effusions.
Area of Science:
- Cardiology
- Internal Medicine
- Diagnostic Imaging
Background:
- Pericardial effusions are fluid accumulation in the pericardial sac.
- Determining the etiology of moderate to severe pericardial effusions can be challenging.
- Echocardiography is a key tool for assessing pericardial effusions.
Purpose of the Study:
- To evaluate the diagnostic utility of effusion size, inflammatory signs, and cardiac tamponade in identifying the causes of moderate or severe pericardial effusions.
- To differentiate between various etiologies of pericardial effusions based on clinical and echocardiographic findings.
Main Methods:
- Retrospective analysis of echocardiograms from a general hospital (January 1990 - April 1996).
- Inclusion criteria: patients with moderate (10-20 mm echo-free space) or severe (>20 mm echo-free space) pericardial effusions.
- Etiologic diagnoses were categorized and analyzed in relation to clinical signs and effusion characteristics.
Main Results:
- 322 patients with moderate (41%) or severe (59%) pericardial effusions were studied.
- Common causes included acute idiopathic pericarditis (20%), iatrogenic effusions (16%), and cancer (13%).
- Inflammatory signs indicated acute idiopathic pericarditis (LR=5.4); severe effusions without inflammation/tamponade suggested chronic idiopathic effusion (LR=20); tamponade without inflammation suggested malignant effusions (LR=2.9).
Conclusions:
- A significant proportion of pericardial effusions stem from known underlying diseases.
- In cases without clear underlying disease, inflammatory signs, effusion size, and presence/absence of cardiac tamponade are valuable indicators for etiological diagnosis.
- Echocardiographic assessment combined with clinical signs aids in diagnosing the cause of pericardial effusions.
Purpose:
To examine whether the size of the effusion, the presence of tamponade, and inflammatory signs are useful in determining the causes of moderate or severe pericardial effusions.
Subjects And Methods:
All echocardiograms performed at a general hospital between January 1990 and April 1996 were screened for pericardial effusion. Patients with moderate (echo-free space of 10 to 20 mm during diastole) or severe (echo-free space >20 mm) effusions were studied.
Results:
We identified 322 patients (166 [52%] men, mean [+/- SD] age 56 +/- 17 years [range 15 to 88 years]), 132 (41%) with moderate and 190 (59%) with severe pericardial effusion. The most frequent etiologic diagnoses were acute idiopathic pericarditis (n = 66 [20%]), iatrogenic effusions (n = 50 [16%]), cancer (n = 43 [13%]), and chronic idiopathic pericardial effusion (n = 29 [9%]). In 192 (60%) of the patients, the cause of the effusion was a known medical condition. In the 130 other patients, inflammatory signs were associated with acute idiopathic pericarditis (likelihood ratio = 5. 4, P < 0.001), severe effusions without inflammatory signs or tamponade were associated with chronic idiopathic pericardial effusion (likelihood ratio = 20, P < 0.001), and tamponade without inflammatory signs was associated with malignant effusions (likelihood ratio = 2.9, P < 0.01).
Conclusions:
In many patients, pericardial effusions are due to a known underlying disease or condition. In patients without underlying diseases, inflammatory signs, the size of effusion, and the presence or absence of cardiac tamponade can be helpful in establishing cause.