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Diagnosis of pericardial abnormalities by 2D-echo: a pathology-echocardiography correlation in 85 patients
S W Hinds1, S A Reisner, A F Amico
1Department of Medicine, University of Rochester, NY.
Abstract:
A blinded pericardial echocardiography-pathology correlation was performed using 85 pericardiectomy or autopsy patients. All patients had two-dimensional (2D)-echocardiography performed within 6 months of autopsy or surgery. 2D-echocardiography was able to detect pericardial abnormalities in 35% of patients with a pathologic pericardium. Obliterative processes, such as fibrosis after open-heart surgery, were particularly not well detected echocardiographically. A specificity of 90% to detect pericardial abnormalities is reported. Acute fibrin strands, malignancies, and chronic fibrous connective tissue involving the pericardium were recognized as abnormal. Interobserver variability does exist, but overall reporting was similar. Specific 2D-echocardiographic signs of pericardial disease require prospective validation including direct pathologic correlation.
Insights
Two-dimensional echocardiography can detect some pericardial abnormalities but struggles with obliterative processes like fibrosis. Further validation is needed for specific echocardiographic signs of pericardial disease.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Pericardial abnormalities can be challenging to diagnose non-invasively.
- Echocardiography is a primary imaging modality for cardiac assessment.
Purpose of the Study:
- To correlate two-dimensional echocardiography findings with pathological findings in the pericardium.
- To assess the diagnostic accuracy of echocardiography for various pericardial abnormalities.
Main Methods:
- A blinded comparison of echocardiography and pathology was conducted.
- Data from 85 patients undergoing pericardiectomy or autopsy were analyzed.
- Echocardiography was performed within six months of surgical or pathological confirmation.
Main Results:
- Two-dimensional echocardiography detected pericardial abnormalities in 35% of patients with confirmed pathology.
- Obliterative processes, such as post-surgical fibrosis, were poorly visualized.
- The specificity for detecting pericardial abnormalities was 90%.
- Acute fibrin strands, malignancies, and chronic fibrous tissue were identified as abnormal findings.
Conclusions:
- Two-dimensional echocardiography has limitations in detecting certain pericardial diseases, especially obliterative conditions.
- Specific echocardiographic signs require prospective validation with direct pathological correlation.
- Further research is necessary to improve echocardiographic assessment of pericardial disease.