CT findings in patients with pericardial effusion: differentiation of malignant and benign disease

This study was designed to validate the usefulness of a CT finding of abnormal pericardial thickening and to investigate the value of associated thoracic changes in predicting the presence of malignant pericardial effusion.

Seventy-four consecutively registered patients with pericardial effusion detected with transthoracic echocardiography were included in the study. The patients fulfilled the following criteria: undergoing pericardial fluid cytologic examination or pericardial tissue biopsy and undergoing chest CT examination less than 30 days after pericardial fluid or tissue examination. CT images were reviewed for the presence of pericardial thickening, the pattern of pericardial thickening, and the presence of pleural effusion and mediastinal lymph node enlargement.

Twenty-eight cases of malignant and 46 cases of benign pericardial effusion were identified. Mean pericardial thickening was greater in association with malignant disease (7.25 +/- 2.91 mm) than with benign disease (4.11 +/- 1.39 mm) (p < 0.05). Abnormal pericardial thickening (p < 0.05) and mediastinal lymph node enlargement (p < 0.001) were statistically significant findings of malignant pericardial effusion. The sensitivity of abnormal pericardial thickening was 42.9% and that of mediastinal lymph node enlargement was 60.7%.

CT findings of irregular pericardial thickening and mediastinal lymphadenopathy have the potential to be reliably specific findings suggesting the presence of malignant pericardial effusion. It would be useful, however, to obtain pericardial fluid or tissue for cause-based management of pericardial effusion, especially in patients with malignant disease.