Echocardiography in helping to determine the causes of pericardial effusion in the Sudanese patients

Pericardial disease is not uncommon in Sudan and the etiology may impose a diagnostic problem. The aim of this study is to determine the etiology of isolated pericardial effusion and to assess the usefulness of the echocardiographic features of the effusion in helping to determine the etiology.Patients and Methods:This is an observational cross-sectional prospective study done from Jan. 2002 to Aug. 2003. Fifty one patients were collected from four centers in Khartoum State. Chest X-ray, Echocardiogram andECG were done for all patients. Pericardiocentesis was done for 35 patients [68.6%]. Specific investigations for the etiological diagnosis were done when appropriate.Results and Conclusion: Male to female ratio was 1.3:1.The age ranged between 4 and 80 years with 68% of patients in the age group 11-40 years. Forty one Patients [82%] were referred with a correct diagnosis of pericardial effusion. The etiology was evident clinically or by specific investigation in 31 patients [61%] and 20 patients [39%] needed pericardiocentesis. The common etiologies were tuberculosis, malignancies, rheumatological, idiopathic and bacterial infection consecutively. The result showed useful echo features to differentiate between tuberculous, occult malignancy and idiopathic etiologies. Thickened Effusion, fibrin strands and shaggy pericardium are suggestive of tuberculosis while thickened Effusion without fibrin strands or shaggy pericardium makes malignancy a competitive diagnosis and the thin appearance of the effusion with shaggy pericardium and no fibrin strands goes more with idiopathic effusion while the features of massiveeffusion, tamponade or the hemorrhagic appearance of the fluid although common in these three etiologies has no much differential value