Etiology of Moderate-to-Large Pericardial Effusion – A Step-by-Step Approach

Abstract

Introduction and Aims: Pericardial effusion is a common finding in clinical practice and its etiologic study has been a clinical challenge. The aim of this study is to evaluate the impact of a step-by-step approach on the etiologic diagnosis.
Methods: Analysis of hospital admissions studying the etiology of
moderate to large pericardial effusions using a step-by-step approach that included general evaluation (clinical history and physical examination), basic diagnostic tests and pericardiocentesis.
Results: The study included 44 patients, 81.8% with large pericardial effusion. Pericardiocentesis for diagnostic purposes was
performed in 43.2% cases. The application of the algorithm led to the definition of an etiology in 70.5% patients. The most common causes were: neoplasm (18.2%), tuberculosis (15.9%), mechanical complication of myocardial infarction (13.6%), post-cardiac
surgery (9.1%), collagen vascular disease (4.5%) and heart failure (4.5%). Phase I (clinical evaluation) of the protocol revealed 50.0% of the diagnosis, phase II (diagnostic tests) 15.9% and phase III (pericardiocentesis) 11.4%. On the follow-up, mean of 15.7
months, there was recurrence of pericardial effusion in 15.2% patients and the mortality rate was 36.4%, without any alteration to
the initial diagnosis. The prognosis was dependent on the etiology.
Conclusions: The use of a step-by-step approach revealed that
the clinical history is the main tool to reach an etiologic diagnosis of a moderate to large pericardial effusion. Pericardiocentesis,
which was diagnostic in 36.9% of the patients, is more accurate in
the definition of the etiology.