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==Overview== | ==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 [[Pericardial Effusion|effusion]]. [[Pericardiocentesis]] should be done in [[patients]] with high susceptibility of [[Neoplastic pericarditis|neoplastic pericarditi]]<nowiki/>s 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 [[Aspiration|aspirated]] and [[Test|tested]] for the presence of [[malignant]] [[Cells (biology)|cells]] and [[tumor marker]]s, particularly in [[patients]] with [[hemorrhagic]] [[Pericardial Effusion|effusion]] without preceding [[trauma]]. However, [[hemorrhagic]] [[pericarditis]] in developing countries could be due to [[tuberculosis]]. [[Sensitivity (tests)|Sensitivity]] of [[cytology|cytological]] [[analysis]] of [[pericardial fluid]] for [[malignant]] [[Cells (biology)|cells]] was 67%, 75%, and 92% in different studies with specificity of 100%. [[Immunohistochemistry]] can be used to distinguish between the [[malignant]] [[Cells (biology)|cells]] and their possible [[origin]].<ref name="pmid12508174">{{cite journal| author=Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW| title=Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block. | journal=Diagn Cytopathol | year= 2003 | volume= 28 | issue= 1 | pages= 1-5 | pmid=12508174 | doi=10.1002/dc.10219 | pmc= | url= }} </ref><ref name="pmid9068950">{{cite journal| author=Mayall F, Heryet A, Manga D, Kriegeskotten A| title=p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology. | journal=Cytopathology | year= 1997 | volume= 8 | issue= 1 | pages= 9-12 | pmid=9068950 | doi= | pmc= | url= }} </ref><ref name="pmid10593777">{{cite journal| author=Atar S, Chiu J, Forrester JS, Siegel RJ| title=Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? | journal=Chest | year= 1999 | volume= 116 | issue= 6 | pages= 1564-9 | pmid=10593777 | doi= | pmc= | url= }} </ref><ref name="pmid2028688">{{cite journal| author=Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U| title=The diagnostic value of pericardial cytology. An analysis of 95 cases. | journal=Acta Cytol | year= 1991 | volume= 35 | issue= 2 | pages= 149-53 | pmid=2028688 | doi= | pmc= | url= }} </ref><ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref><ref name="pmid9149572">{{cite journal| author=Meyers DG, Meyers RE, Prendergast TW| title=The usefulness of diagnostic tests on pericardial fluid. | journal=Chest | year= 1997 | volume= 111 | issue= 5 | pages= 1213-21 | pmid=9149572 | doi= | pmc= | url= }} </ref> | |||
* [[Aspirate|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 (tests)|sensitivity]] of 97%, which compares quite favorably to a [[blind]] [[biopsy]] which has a low [[Sensitivity (tests)|sensitivity]] of 55-65%.<ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref><ref name="pmid8840855">{{cite journal| author=Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A et al.| title=Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. | journal=Circulation | year= 1996 | volume= 94 | issue= 7 | pages= 1635-41 | pmid=8840855 | doi= | pmc= | url= }} </ref> | |||
==2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)<ref name="AdlerCharron2015">{{cite journal|last1=Adler|first1=Yehuda|last2=Charron|first2=Philippe|last3=Imazio|first3=Massimo|last4=Badano|first4=Luigi|last5=Barón-Esquivias|first5=Gonzalo|last6=Bogaert|first6=Jan|last7=Brucato|first7=Antonio|last8=Gueret|first8=Pascal|last9=Klingel|first9=Karin|last10=Lionis|first10=Christos|last11=Maisch|first11=Bernhard|last12=Mayosi|first12=Bongani|last13=Pavie|first13=Alain|last14=Ristić|first14=Arsen D.|last15=Sabaté Tenas|first15=Manel|last16=Seferovic|first16=Petar|last17=Swedberg|first17=Karl|last18=Tomkowski|first18=Witold|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>== | |||
===Recommendations for the general diagnostic work-up of pericardial diseases=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' In all cases of suspected [[pericardial disease]] a first [[diagnostic]] evaluation is recommended with: | |||
– [[auscultation]] | |||
– [[ECG]] | |||
– [[transthoracic echocardiography]] | |||
– [[chest X-ray]] | |||
– routine [[blood tests]], including markers of [[inflammation]] (i.e., [[CRP]] and/or [[ESR]]), white [[blood cell count]] with differential count, [[renal function]] and [[Liver function tests|liver tests]] and [[myocardial]] [[Lesions|lesion]] [[Test|tests]] ([[CK]], [[Troponin|troponins]]). | |||
'''2.''' [[CT]] and/or [[CMR]] are recommended as [[second]]-level [[testing]] for [[diagnostic]] workup in pericarditis. | |||
[ | '''3.''' [[Pericardiocentesis]] or [[Drain (surgery)|surgical drainage]] are [[Indication (medicine)|indicated]] for [[cardiac tamponade]] or suspected [[bacterial]] and [[neoplastic pericarditis]]. | ||
'''4.''' Further testing is [[Indication (medicine)|indicated]] in high-risk [[patients]] (defined as above) according to the [[clinical]] [[conditions]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
== | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon" |<nowiki></nowiki> [[Percutaneous]] or [[surgical]] [[pericardial]] [[biopsy]] may be considered in selected cases of suspected [[neoplastic]] or [[tuberculous pericarditis]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence:]]<nowiki/> [[ACC AHA Guidelines Classification Scheme#Level of Evidence|C]])'' | |||
|} | |||
===Recommendations for the diagnosis and therapy of viral pericarditis=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon" |<nowiki></nowiki> For the definited [[diagnosis]] of [[viral pericarditis]], a comprehensive workup of [[histological]], [[cytological]], [[Immunohistochemistry|immunohistological]] and [[molecular]] investigations in [[pericardial fluid]] and peri-/[[epicardial]] [[biopsies]] should be considered. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]]<nowiki/>)'' | |||
|} | |||
===Recommendations for the diagnosis of purulent pericarditis=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''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 [[Culture medium|cultures]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
==References== | ==References== | ||
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[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 23:39, 29 July 2020
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Pericarditis other diagnostic studies On the Web |
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American Roentgen Ray Society Images of Pericarditis other diagnostic studies |
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Risk calculators and risk factors for Pericarditis other diagnostic studies |
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)
|
| 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)
|
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.