PERICARDIOSCOPY IN THE ETIOLOGIC DIAGNOSIS OF PERICARDIAL-EFFUSION IN141 CONSECUTIVE PATIENTS

Background Although previous small series have documented the utility of pericardioscopy for accurate etiologic diagnosis of pericardial eff usion, this technique remains underused. The aim of our study was to a ssess the benefits and risks of surgical pericardioscopy in a large pr ospective series. Methods and Results One hundred forty-one consecutiv e patients with unexplained pericardial effusion underwent 142 pericar dioscopies with a rigid mediastinoscope. For each patient, the etiolog ic data obtained by pericardioscopy (visualization of pericardium, gui ded biopsies, subxiphoid window biopsy, and fluid analysis) were compa red with the results that would have been obtained with only conventio nal surgical drainage and biopsy (subxiphoid window biopsy and fluid a nalysis). After complete workup, a specific cause was found in 69 case s (48.6%); the other 73 cases were considered idiopathic effusions (51 .4%). Procedural and in-hospital mortality was 8 of 141 patients (5.6% ). No death was directly attributable to pericardioscopy. During long- term follow-up (median duration, 24 months; range, 6 to 96), a previou sly unrecognized cause was discovered in 6 patients (4%). By comparing the areas under the receiver-operating characteristic curves, the dia gnostic advantage of pericardioscopy was significant for the whole ser ies (pericardioscopy, 0.98 +/- 0.011; conventional surgical drainage, 0.89 +/- 0.029; P<.001). The increase in sensitivity was more marked f or some types such as neoplastic (21%), radiation-induced (100%), or p urulent (83%) effusions. Conclusions Our data demonstrate that pericar dioscopy increases the diagnostic sensitivity of surgical pericardial drainage and biopsy without specific risk.