Clinical spectrum of radiation induced pericarditis

A series of seven patients diagnosed as having radiation induced pericarditis were reviewed and compared to those reported in the literature. They constituted 6.8 per cent of all patients with the diagnosis of pericarditis seen in a five-year period. These patients had the diagnosis proven by autopsy or by the absence of tumor cells from the pericardial fluid and/or surgical biopsy. The echocardiogram and cardiac catheterization were found to be specific diagnostic tools. Recommendations are made for a therapeutic approach to these patients. The diagnosis of this condition depends on a high index of suspicion, and close follow-up of patients who have received intense radiotherapy to the chest. Recommendations are made for prophylaxis. We challenge the pessimistic approach towards the cancer patient who develops recurrent pericardial fluid or pleural effusion due to radiation induced pericarditis. We advocate an aggressive diagnostic approach and therapy which should be related to the degree of hemodynamic impairment.