Bloody pericardial effusion in patients with cardiac tamponade - Is the cause cancerous, tuberculous, or latrogenic in the 1990s?

Study objectives: The decrease in incidence of tuberculosis, along with the increase in invasive cardiovascular procedures. may have changed the frequ ency of causes of bloody pericardial effusion associated with cardiac tampo nade, although this is not yet recognized by medical textbooks. We analyzed the causes of bloody pericardial effusion in the clinical setting of cardi ac tamponade in the 1990s; patients' survival; the effect of laboratory res ults on discharge diagnosis; and how often bloody pericardial effusion is a presenting manifestation of a new malignancy or tuberculosis. Design: Retrospective, observational, single-center study. Setting: community hospital. Patients: The charts of all patients who underwent pericardiocentesis for c ardiac tamponade and hall bloody pericardial effusion were retrospectively reviewed. Results: Of 150 patients who had pericardiocentesis for relieving cardiac t amponade and 96 patients (64%) had a bloody pericardial effusion. The most common cause of bloody pericardial effusion was iatrogenic disease (31%), n amely, secondary to invasive cardiac procedures. The other common causes we re malignancy (26%), complications of atherosclerotic heart disease (11%), and idiopathic disease (10%). Tuberculosis was detected as a cause of blood y pericardial effusion in one patient and presumed to be the cause in anoth er patient. Bloody pericardial effusion was found to be a presenting manife station of a newly diagnosed malignancy in two patients. The patients in th e idiopathic and introgenic groups were all alive and had no recurrence of pelicardial effusion at 24 +/- 27 and 33 +/- 21 months after hospital disch arge, respectively, whereas 80% of patients with malignancy related bloody effusions died within 8 +/- 6 months. Conclusions: In a patient population that is reasonably representative of t hat in most community hospitals in the United States, the most common cause of bloody pericardial effusion in patients with signs or symptoms of cardi ac tamponade is now iatrogenic disease. Of the noniatrogenic causes, malign ancy, complications of acute myocardial infarction, and idiopathic disease predominated, Hemorrhagic tuberculous pericardial effusions are uncommon an d may Likely reflect a low incidence of cardiac tuberculosis in community h ospitals in the United States.