Idiopathic Pericardial Effusions in Children: Workup and Final Diagnoses

Area of Science:

• Pediatric Cardiology
• Internal Medicine
• Diagnostic Workup

Background:

• Pediatric idiopathic pericardial effusions are common and frequently have prolonged clinical courses.
• The diagnostic workup for these effusions is often not standardized.
• The final etiology of these effusions may not be initially recognized.

Purpose of the Study:

• To investigate the diagnostic workup and final etiology of pediatric pericardial effusions initially diagnosed as idiopathic.
• To determine the rate at which initially idiopathic pericardial effusions are later found to have an underlying cause.

Main Methods:

• Retrospective cohort study of children (<18 years) with pericardial effusions from 1/1/1990 to 10/1/2019.
• Effusions were analyzed based on etiology, with a focus on those initially diagnosed as idiopathic.
• Data abstracted included effusion size, diagnostic workup details, final diagnosis, and time to resolution.

Main Results:

• Out of 366 effusions, 42 (11.5%) were initially diagnosed as idiopathic.
• The diagnostic workup was not standardized, involving up to six laboratory tests.
• Of the initially idiopathic effusions, 12 (29%) were later diagnosed with an underlying etiology (autoimmune, neoplastic, infectious, renal).

Conclusions:

• Children initially diagnosed with idiopathic pericardial effusions have an underlying etiologic diagnosis in 29% of cases.
• A standardized diagnostic workup may prevent delays in definitive diagnosis and treatment for pediatric pericardial effusions.
• Further research into standardized protocols for evaluating pediatric pericardial effusions is warranted.