Pericardial effusion concomitant with specific heart muscle disease in systemic sarcoidosis

Eighty-one consecutive patients, 32 males and 49 females, with biopsy-proven systemic sarcoidosis, none of whom had clinical evidence of heart disease, underwent M-mode and two-dimensional echocardiography, ECG and chest X-ray in order to investigate the frequency of sarcoid pericardial effusion. Mild or moderate size pericardial accumulations were found by echocardiography in 17 patients (21%), four males and 13 females (mean age 49.7 +/- 9.2 years). Pericardial effusion could not be correlated with clinical symptoms or physical signs, chest X-ray and ECG findings. All 17 patients with pericardial effusion were also studied by technetium-99m pyrophosphate radionuclide myocardial imaging, targeting to reveal the coincident presence of specific heart muscle disease or 'infiltrative cardiomyopathy'. The results showed abnormal scans in 13 of 14 patients with technically satisfactory scans, indicating the coincidence of sarcoid myocardial involvement in 92% of the patients with pericardial effusion, representing 16% of the total population studied. Thus, pericardial effusion in sarcoidosis should not be considered a rare condition, while concomitant presence of positive technetium-99m pyrophosphate radionuclide myocardial imaging could suggest that sarcoid pericardial effusion is often accompanied by specific heart muscle disease. This observation has not been well established previously in the literature.