ETIOLOGIC DIAGNOSIS OF PERICARDIAL DISEASE - THE VALUE OF ROUTINE TESTS DURING SURGICAL-PROCEDURES

BACKGROUND: The cause of pericardial disease often is unclear. Pericar dial surgery provides a unique opportunity to obtain tissue and fluid samples for diagnostic tests. We report our experience with these test s and assess their value in etiologic determination. STUDY DESIGN: The medical records of 92 who underwent 95 operations for pericardial dis ease were reviewed. The procedures included 75 biopsies and drainages and 20 pericardiectomies. We analyzed the diagnostic yields of routine histology of the removed pericardial specimens, together with culture , cytology, and biochemistry examinations of the fluid drained. RESULT S: A specific etiologic diagnosis was obtained in 20 patients (22 perc ent): 12 neoplasias, 5 infections (1 bacterial, 4 tuberculoses), 2 chy lopericardia, and 1 amyloidosis. Diagnosis was made histologically in 10 (10.5 percent) of 95 examinations, cytologically in 12 (16 percent) of 73 examinations, by culture in 5 (7 percent) of 73 examinations, a nd by biochemistry in 2 (3 percent) of 73 examinations. Pericardial di sease was the first manifestation of an underlying extrapericardial di sorder in 11 patients (12 percent), and 8 of these patients had neopla sias and 3 had tuberculoses. Twenty-seven patients (29 percent) had un derlying neoplastic disease, and in 15 patients, neither cytology nor histology revealed neoplastic involvement of the pericardium. In 2 of the 15 patients, who died shortly after the operation, pericardial inv asion was demonstrated at postmortem examination. CONCLUSIONS: One fif th of the patients had a specific etiologic diagnosis with important i mplications for prognosis and management, supporting the routine use o f diagnostic tests in all pericardial surgical procedures. Negative cy tology and histology results do not rule out pericardial invasion in p atients with neoplastic disease.