ETIOLOGY OF LARGE PERICARDIAL-EFFUSIONS

PuRPOSE: To determine the effectiveness of the preoperative evaluation and overall diagnostic efficacy of subxiphoid pericardial biopsy with fluid drainage in patients with new, large pericardial effusions. DES IGN: A prospective interventional case series of consecutive patients admitted with new, large pericardial effusions. PATIENTS AND METHoDs: Fifty-seven of 75 consecutive patients admitted to a university tertia ry-care center and a university-affiliated Veterans Administration Med ical Center with new, large pericardial effusions were studied over a 20-month period. Each patient was assessed by a comprehensive preopera tive evaluation followed by subxiphoid pericardiotomy. The patients' t issue and fluid samples were studied pathologically and cultured for a erobic and anaerobic bacteria, fungi, mycobacteria, mycoplasmas, and v iruses. RESULTS: A diagnosis was made in 53 (93%) patients. The princi ple diagnoses consisted of malignancy in 13 (23%) patients; viral infe ction in 8 (14%) patients; radiation-induced inflammation in 8 (14%) p atients; collagen-vascular disease in 7 (12%) patients; and uremia in 7 (12%) patients. No diagnosis was made in four (7%) patients. A varie ty of unexpected organisms were cultured from either pericardial fluid or tissue: cytomegalovirus (three), Mycoplasma pneumoniae (two), herp es simplex virus (one), Mycobacterium avium-intracellulare (one), and Mycobacterium chelonei (one). The pericardial fluid yielded a diagnosi s in 15 (26%) patients, 11 of whom had malignant effusions. The examin ation of pericardial tissue was useful in the diagnosis of 13 (23%) pa tients, 8 of whom had an infectious agent cultured. Of the 57 patients undergoing surgery, the combined diagnostic yield from both fluid and tissue was 19 patients (33%). CONCLUSIONs: A systematic preoperative evaluation in conjunction with fluid and tissue analysis following sub xiphoid pericardiotomy yields a diagnosis in the majority of patients with large pericardial effusions. This approach may also result in the culturing of ''unusual'' infectious organisms from pericardial tissue and fluid.