Pericarditis other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]
Overview
Echocardiography guided pericardiocentesis may be helpful in the diagnosis of the pericarditis etiology. Pericardial fluid aspiration for cytology and immunohistochemistry analysis should be done in pericarditis with effusion. Pericardiocentesis should be done in patients with high susceptibility of neoplastic pericarditis which cytology analysis for malignancy was negative.
Other Diagnostic Studies
Other diagnostic studies for pericarditis include:
Diagnostic Pericardiocentesis
- Pericardiocentesis is a relatively safe procedure when guided by echocardiography, especially when large free anterior pericardial effusion is present. Pericardial fluid should be aspirated and tested for the presence of malignant cells and tumor markers, particularly in patients with hemorrhagic effusion without preceding trauma. However, hemorrhagic pericarditis in developing countries could be due to tuberculosis. Sensitivity of cytological analysis of pericardial fluid for malignant cells was 67%, 75%, and 92% in different studies with specificity of 100%. Immunohistochemistry can be used to distinguish between the malignant cells and their possible origin.[1][2][3][4][5][6]
- Aspirated fluid can also be used for the following tests:
- Gram staining
- Acid-fast staining
- Microbial culture
Pericardial Biopsy
- If the clinical suspicion of malignancy is high, and if the results of cytology testing from the pericardiocentesis are negative, consideration should be given to performing a pericardial biopsy. This can be performed via either a subxiphoid or transthoracic pericardiostomy or alternatively by pericardioscopy. The advantages of pericardioscopy include helping to directly visualize the pericardium as well as helping to collect the biopsy sample. Pericardioscopy has an excellent sensitivity of 97%, which compares quite favorably to a blind biopsy which has a low sensitivity of 55-65%.[5][7]
2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)[8]
Recommendations for the general diagnostic work-up of pericardial diseases
| Class I |
| 1. In all cases of suspected pericardial disease a first diagnostic evaluation is recommended with:
– ECG – transthoracic echocardiography – routine blood tests, including markers of inflammation (i.e., CRP and/or ESR), white blood cell count with differential count, renal function and liver tests and myocardial lesion tests (CK, troponins). 2. CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis. 3. Pericardiocentesis or surgical drainage are indicated for cardiac tamponade or suspected bacterial and neoplastic pericarditis. 4. Further testing is indicated in high-risk patients (defined as above) according to the clinical conditions. (Level of Evidence: C)
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| Class IIb |
| Percutaneous or surgical pericardial biopsy may be considered in selected cases of suspected neoplastic or tuberculous pericarditis. (Level of Evidence: C) |
Recommendations for the diagnosis and therapy of viral pericarditis
| Class IIa |
| For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered. (Level of Evidence: C) |
Recommendations for the diagnosis of purulent pericarditis
| Class I |
| 1. Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis.
2. It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. (Level of Evidence: C)
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References
- ↑ Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW (2003). "Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block". Diagn Cytopathol. 28 (1): 1–5. doi:10.1002/dc.10219. PMID 12508174.
- ↑ Mayall F, Heryet A, Manga D, Kriegeskotten A (1997). "p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology". Cytopathology. 8 (1): 9–12. PMID 9068950.
- ↑ Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
- ↑ Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U (1991). "The diagnostic value of pericardial cytology. An analysis of 95 cases". Acta Cytol. 35 (2): 149–53. PMID 2028688.
- ↑ 5.0 5.1 Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
- ↑ Meyers DG, Meyers RE, Prendergast TW (1997). "The usefulness of diagnostic tests on pericardial fluid". Chest. 111 (5): 1213–21. PMID 9149572.
- ↑ Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A; et al. (1996). "Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients". Circulation. 94 (7): 1635–41. PMID 8840855.
- ↑ Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.