Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2000 Dec;76(902):809–813. doi: 10.1136/pmj.76.902.809

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

C Gibbs 1, R Watson 1, S Singh 1, G Lip 1
PMCID: PMC1741828  PMID: 11085787

Abstract

The aim of the study was to determine the aetiology of large and symptomatic pericardial effusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial effusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of Afro-Caribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an effective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low.


Keywords: tuberculosis; pericardial effusions; percutaneous pericardiocentesis

Full Text

The Full Text of this article is available as a PDF (111.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alcan K. E., Zabetakis P. M., Marino N. D., Franzone A. J., Michelis M. F., Bruno M. S. Management of acute cardiac tamponade by subxiphoid pericardiotomy. JAMA. 1982 Feb 26;247(8):1143–1148. [PubMed] [Google Scholar]
  2. Ball J. B., Morrison W. L. Cardiac tamponade. Postgrad Med J. 1997 Mar;73(857):141–145. doi: 10.1136/pgmj.73.857.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Callahan J. A., Seward J. B., Nishimura R. A., Miller F. A., Jr, Reeder G. S., Shub C., Callahan M. J., Schattenberg T. T., Tajik A. J. Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients. Am J Cardiol. 1985 Feb 1;55(4):476–479. doi: 10.1016/0002-9149(85)90397-2. [DOI] [PubMed] [Google Scholar]
  4. Chuttani K., Pandian N. G., Mohanty P. K., Rosenfield K., Schwartz S. L., Udelson J. E., Simonetti J., Kusay B. S., Caldeira M. E. Left ventricular diastolic collapse. An echocardiographic sign of regional cardiac tamponade. Circulation. 1991 Jun;83(6):1999–2006. doi: 10.1161/01.cir.83.6.1999. [DOI] [PubMed] [Google Scholar]
  5. Chuttani K., Tischler M. D., Pandian N. G., Lee R. T., Mohanty P. K. Diagnosis of cardiac tamponade after cardiac surgery: relative value of clinical, echocardiographic, and hemodynamic signs. Am Heart J. 1994 Apr;127(4 Pt 1):913–918. doi: 10.1016/0002-8703(94)90561-4. [DOI] [PubMed] [Google Scholar]
  6. Cooper J. P., Oliver R. M., Currie P., Walker J. M., Swanton R. H. How do the clinical findings in patients with pericardial effusions influence the success of aspiration? Br Heart J. 1995 Apr;73(4):351–354. doi: 10.1136/hrt.73.4.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Corey G. R., Campbell P. T., Van Trigt P., Kenney R. T., O'Connor C. M., Sheikh K. H., Kisslo J. A., Wall T. C. Etiology of large pericardial effusions. Am J Med. 1993 Aug;95(2):209–213. doi: 10.1016/0002-9343(93)90262-n. [DOI] [PubMed] [Google Scholar]
  8. Desai H. N. Tuberculous pericarditis. A review of 100 cases. S Afr Med J. 1979 May 26;55(22):877–880. [PubMed] [Google Scholar]
  9. Eisenberg M. J., Dunn M. M., Kanth N., Gamsu G., Schiller N. B. Diagnostic value of chest radiography for pericardial effusion. J Am Coll Cardiol. 1993 Aug;22(2):588–593. doi: 10.1016/0735-1097(93)90069-d. [DOI] [PubMed] [Google Scholar]
  10. Engel P. J., Hon H., Fowler N. O., Plummer S. Echocardiographic study of right ventricular wall motion in cardiac tamponade. Am J Cardiol. 1982 Nov;50(5):1018–1021. doi: 10.1016/0002-9149(82)90411-8. [DOI] [PubMed] [Google Scholar]
  11. Fowler N. O. Cardiac tamponade. A clinical or an echocardiographic diagnosis? Circulation. 1993 May;87(5):1738–1741. doi: 10.1161/01.cir.87.5.1738. [DOI] [PubMed] [Google Scholar]
  12. Fowler N. O., Manitsas G. T. Infectious pericarditis. Prog Cardiovasc Dis. 1973 Nov-Dec;16(3):323–336. doi: 10.1016/s0033-0620(73)80004-0. [DOI] [PubMed] [Google Scholar]
  13. Fowler N. O. Tuberculous pericarditis. JAMA. 1991 Jul 3;266(1):99–103. [PubMed] [Google Scholar]
  14. Fyke F. E., 3rd, Tancredi R. G., Shub C., Julsrud P. R., Sheedy P. F., 2nd Detection of intrapericardial hematoma after open heart surgery: the roles of echocardiography and computed tomography. J Am Coll Cardiol. 1985 Jun;5(6):1496–1499. doi: 10.1016/s0735-1097(85)80369-7. [DOI] [PubMed] [Google Scholar]
  15. Guberman B. A., Fowler N. O., Engel P. J., Gueron M., Allen J. M. Cardiac tamponade in medical patients. Circulation. 1981 Sep;64(3):633–640. doi: 10.1161/01.cir.64.3.633. [DOI] [PubMed] [Google Scholar]
  16. HAGEMAN J. H., D ESOPO N. D., GLENN W. W. TUBERCULOSIS OF THE PERICARDIUM. A LONG-TERM ANALYSIS OF FORTY-FOUR PROVED CASES. N Engl J Med. 1964 Feb 13;270:327–332. doi: 10.1056/NEJM196402132700702. [DOI] [PubMed] [Google Scholar]
  17. Hoit B. D., Gabel M., Fowler N. O. Cardiac tamponade in left ventricular dysfunction. Circulation. 1990 Oct;82(4):1370–1376. doi: 10.1161/01.cir.82.4.1370. [DOI] [PubMed] [Google Scholar]
  18. Kopecky S. L., Callahan J. A., Tajik A. J., Seward J. B. Percutaneous pericardial catheter drainage: report of 42 consecutive cases. Am J Cardiol. 1986 Sep 15;58(7):633–635. doi: 10.1016/0002-9149(86)90290-0. [DOI] [PubMed] [Google Scholar]
  19. Kronzon I., Cohen M. L., Winer H. E. Diastolic atrial compression: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1983 Oct;2(4):770–775. doi: 10.1016/s0735-1097(83)80318-0. [DOI] [PubMed] [Google Scholar]
  20. Kwasnik E. M., Koster K., Lazarus J. M., Sloss L. J., Mee R. B., Cohn L. H., Collins J. J. Conservative management of uremic pericardial effusions. J Thorac Cardiovasc Surg. 1978 Nov;76(5):629–632. [PubMed] [Google Scholar]
  21. Leimgruber P. P., Klopfenstein H. S., Wann L. S., Brooks H. L. The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study. Circulation. 1983 Sep;68(3):612–620. doi: 10.1161/01.cir.68.3.612. [DOI] [PubMed] [Google Scholar]
  22. Mercé J., Sagristà-Sauleda J., Permanyer-Miralda G., Soler-Soler J. Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade? Am J Med. 1998 Aug;105(2):106–109. doi: 10.1016/s0002-9343(98)00192-2. [DOI] [PubMed] [Google Scholar]
  23. Ng T. T., Strang J. I., Wilkins E. G. Serodiagnosis of pericardial tuberculosis. QJM. 1995 May;88(5):317–320. [PubMed] [Google Scholar]
  24. Nugue O., Millaire A., Porte H., de Groote P., Guimier P., Wurtz A., Ducloux G. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. 1996 Oct 1;94(7):1635–1641. doi: 10.1161/01.cir.94.7.1635. [DOI] [PubMed] [Google Scholar]
  25. Pepi M., Muratori M., Barbier P., Doria E., Arena V., Berti M., Celeste F., Guazzi M., Tamborini G. Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences. Br Heart J. 1994 Oct;72(4):327–331. doi: 10.1136/hrt.72.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Permanyer-Miralda G., Sagristá-Sauleda J., Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985 Oct 1;56(10):623–630. doi: 10.1016/0002-9149(85)91023-9. [DOI] [PubMed] [Google Scholar]
  27. Quale J. M., Lipschik G. Y., Heurich A. E. Management of tuberculous pericarditis. Ann Thorac Surg. 1987 Jun;43(6):653–655. doi: 10.1016/s0003-4975(10)60243-3. [DOI] [PubMed] [Google Scholar]
  28. SCHRIRE V. Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period. S Afr Med J. 1959 Sep 26;33:810–817. [PubMed] [Google Scholar]
  29. Sagristà-Sauleda J., Permanyer-Miralda G., Soler-Soler J. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol. 1988 Apr;11(4):724–728. doi: 10.1016/0735-1097(88)90203-3. [DOI] [PubMed] [Google Scholar]
  30. Singh S., Wann L. S., Schuchard G. H., Klopfenstein H. S., Leimgruber P. P., Keelan M. H., Jr, Brooks H. L. Right ventricular and right atrial collapse in patients with cardiac tamponade--a combined echocardiographic and hemodynamic study. Circulation. 1984 Dec;70(6):966–971. doi: 10.1161/01.cir.70.6.966. [DOI] [PubMed] [Google Scholar]
  31. Strang G., Latouf S., Commerford P., Roditi D., Duncan-Traill G., Barlow D., Forder A. Bedside culture to confirm tuberculous pericarditis. Lancet. 1991 Dec 21;338(8782-8783):1600–1601. doi: 10.1016/0140-6736(91)92433-3. [DOI] [PubMed] [Google Scholar]
  32. Strang J. I., Kakaza H. H., Gibson D. G., Allen B. W., Mitchison D. A., Evans D. J., Girling D. J., Nunn A. J., Fox W. Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei. Lancet. 1988 Oct 1;2(8614):759–764. doi: 10.1016/s0140-6736(88)92415-4. [DOI] [PubMed] [Google Scholar]
  33. Strang J. I., Kakaza H. H., Gibson D. G., Girling D. J., Nunn A. J., Fox W. Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei. Lancet. 1987 Dec 19;2(8573):1418–1422. doi: 10.1016/s0140-6736(87)91127-5. [DOI] [PubMed] [Google Scholar]
  34. Strang J. I. Tuberculous pericarditis in Transkei. Clin Cardiol. 1984 Dec;7(12):667–670. doi: 10.1002/clc.4960071208. [DOI] [PubMed] [Google Scholar]
  35. Vaitkus P. T., Herrmann H. C., LeWinter M. M. Treatment of malignant pericardial effusion. JAMA. 1994 Jul 6;272(1):59–64. [PubMed] [Google Scholar]
  36. Wilkes J. D., Fidias P., Vaickus L., Perez R. P. Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer. 1995 Oct 15;76(8):1377–1387. doi: 10.1002/1097-0142(19951015)76:8<1377::aid-cncr2820760813>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES