Etiology, diagnosis and management of severe pericardial effusion: A single center experience

Objective: To show etiology, diagnostic methods, and treatment options of patients with severe pericardial effusion determined after echocardiography. Methods: In this study, we retrospectively analyzed etiology, diagnosis and treatment options of 43 patients with severe pericardial effusions (i.e. effusions more than 20 mm either in front of the right ventricle or posterior to left ventricle as assessed by transthoracic echocardiography). The pericardiocentesis procedures were performed via subxiphoid approach. Glucose, protein, lactate dehydrogenase levels, polymerase chain reaction for tuberculosis, cytological, microbiological examinations and cultures were obtained from pericardial fluid. Results: Cardiac tamponade was diagnosed in 23 patients (54%) and pericardiocentesis was immediately performed in these cases. Twenty patients who were unresponsive to empirical treatment, underwent pericardiocentesis to evaluate etiology and treatment.. Pericardial fluid was found to be exudate in 36 patients (83.7%) and transudate in 7 patients (16.2%). The most common causes were malignancy (26%), and uremia (16%) while idiopathic cases constituted 23% of the patient group. While malignant pericardial effusion was more common in males, idiopathic etiology and uremia were more common in female patients. Conclusion: Pericardiocentesis is the gold standard for clarifying the etiology and is also a lifesaving measure for cardiac tamponade. Delineating the specific etiology is particularly important for cases that do not respond to empirical treatment. A thorough history and physical examination, together with pericardiocentesis in selected cases will enable the accurate diagnosis of specific etiology and starting the treatment for this etiology