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

Year 2014, Volume: 41 Issue: 4, 629 - 634, 01.12.2014

Ahmet Göktuğ Ertem Mehmet Aytürk Mustafa Duran Selçuk Özkan Hamza Sunman Harun Kılıç Ekrem Yeter

https://doi.org/10.5798/diclemedj.0921.2014.04.0489

Cited By: 1

Abstract

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. Key words: Pericardiocentesis, echocardiography, effusion

Keywords

Pericardiocentesis, echocardiography, effusion

Ciddi perikardiyal efüzyonun etiyolojisi, tanısı ve yönetimi: Tek merkez deneyimi

Abstract

Amaç: Ekokardiyografi sonrasında saptanan ciddi perikardiyal efüzyonu olan hastalarda etiyoloji, tanı metotları ve tedavi seçeneklerini göstermektir. Yöntemler: Bu çalışmada geriye dönük olarak, ciddi perikardiyal efüzyonu olan 43 hastayı (transtorasik ekokardiyografide sağ ventrikül önünde veya sol ventrikül arkasında 20 mm\'den fazla olan efüzyon, kalbi çevreleyen efüzyon) etiyoloji, tanı ve tedavi seçenekleri açısından analiz ettik. Perikardiyosentez prosedürü subksifoid yol üzerinden yapıldı. Perikardiyal sıvıdan glukoz, protein, laktat dehidrojenaz, tüberküloz için polimeraz zincir reaksiyonu, sitolojik, mikrobiyolojik testler ve kültür çalışıldı. Bulgular: Yirmi üç hastada (%54) hastada kardiyak tamponat tanısı konuldu ve erken perikardiyosentez uygulandı. Ampirik tedaviye yanıtı olmayan yirmi hastaya, etiyoloji ve tedaviyi yönetmek açısından perikardiyosentez uygulandı. Otuzaltı hastada (%83,7) perikardiyal sıvı eksüda iken, 7 hastada (%16,2) transüda idi. En sık görülen nedenler malignensi (%26), ve üremi (%16) iken etiyolojisi belirlenemeyen hastalar da %23'ü oluşturuyordu. Malign perikardiyal efüzyon erkeklerde sık görülürken, üremiye bağlı olan ve nedeni belirlenemeyen effüzyonlar kadın hastalarda sık görülmekteydi. Sonuçlar: Perikardiyosentez, kardiyak tamponatta hayat kurtarıcı bir tedavidir ve etiyolojiyi netleştirmede altın standarttır. Özellikle, ampirik tedavinin başarısız olduğu durumlarda, spesifik etiyolojiyi saptamak önemlidir. Dikkatli alınan medikal öykü, detaylı fizik muayene ve gerekirse perikardiyosentez prosedürü, spesifik etiyoloji için tanı koymada ve hastalığın yönetiminde yardımcı olacaktır.

Keywords

Perikardiyosentez, ekokardiyografi, efüzyon

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