Pericarditis laboratory studies: Difference between revisions
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{{Pericarditis}} | {{Pericarditis}} | ||
{{CMG}} | {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S. | ||
==Inflammatory | ==Inflammatory Markers== | ||
The following inflammatory markers are often elevated: | The following inflammatory markers are often elevated: | ||
*[[Complete Blood Count|CBC]] | *[[Complete Blood Count|CBC]] | ||
*[[C-reactive protein]] | *[[C-reactive protein]] | ||
*Erythrocyte sedimentation rate [[ESR]] | *Erythrocyte sedimentation rate ([[ESR]]) | ||
==Markers of Myonecrosis== | ==Markers of Myonecrosis== | ||
| Line 23: | Line 23: | ||
==Gallium-67 Imaging== | ==Gallium-67 Imaging== | ||
Gallium-67 scanning may help identify inflammatory and [[leukemic]] infiltrations | Gallium-67 scanning may help identify inflammatory and [[leukemic]] infiltrations | ||
==Diagnositic Pericardiocentesis== | |||
Pericardial fluid should be aspirated and tested for presence of malignant cells and tumor markers particularly in patients with hemorrhagic effusion without preceding trauma<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>. However, hemorrhagic pericarditis in developing countries could be due to [[tuberculosis]]. Sensitivity of [[cytology|cytological]] analysis of pericardial fluid for malignant cells were 67%<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>, 75%<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> and 92%<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> in different studies with specificity of 100%. [[Immunohistochemistry]] can be used to distinguish between the malignant 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>. | |||
Fluid aspirated can also be used for following tests: | |||
*[[Gram staining]] | |||
*[[Acid-fast]] staining | |||
*Culture | |||
==Pericardial Biopsy== | |||
Negative cytology should be followed with by pericardial biopsy performed via a subxiphoid or transthoracic [[pericardiostomy]] or by [[pericardioscopy]]. The pericardioscopy which helps in direct visualization of pericardium and collecting biopsy sample, has a good sensitivity of 97%<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> when compared to blind biopsy which has a low sensitivity of 55-65%. | |||
==References== | ==References== | ||
Revision as of 19:52, 19 July 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.
Inflammatory Markers
The following inflammatory markers are often elevated:
- CBC
- C-reactive protein
- Erythrocyte sedimentation rate (ESR)
Markers of Myonecrosis
The following markers of myonecrosis may be elevated if there is involvement of the underlying myocardium:
- Creatine Kinase: Acute pericarditis may be associated with a modest increase in serum creatine kinase MB (CK-MB) depending upon the extent of involvement of the underlying myocardium.[1][2]
- Cardiac troponin I (cTnI)[3][4].
- LDH: depends on the extent of myocardial involvement
- Serum myoglobin
Gallium-67 Imaging
Gallium-67 scanning may help identify inflammatory and leukemic infiltrations
Diagnositic Pericardiocentesis
Pericardial fluid should be aspirated and tested for presence of malignant cells and tumor markers particularly in patients with hemorrhagic effusion without preceding trauma[5]. However, hemorrhagic pericarditis in developing countries could be due to tuberculosis. Sensitivity of cytological analysis of pericardial fluid for malignant cells were 67%[6], 75%[7] and 92%[8] in different studies with specificity of 100%. Immunohistochemistry can be used to distinguish between the malignant cells and their possible origin[9][10].
Fluid aspirated can also be used for following tests:
- Gram staining
- Acid-fast staining
- Culture
Pericardial Biopsy
Negative cytology should be followed with by pericardial biopsy performed via a subxiphoid or transthoracic pericardiostomy or by pericardioscopy. The pericardioscopy which helps in direct visualization of pericardium and collecting biopsy sample, has a good sensitivity of 97%[7][11] when compared to blind biopsy which has a low sensitivity of 55-65%.
References
- ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
- ↑ Karjalainen J, Heikkila J (1986). ""Acute pericarditis": myocardial enzyme release as evidence for myocarditis". Am Heart J. 111 (3): 546–52. doi:10.1016/0002-8703(86)90062-1. PMID 3953365.
- ↑ Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". Eur Heart J. 21 (10): 832–6. doi:10.1053/euhj.1999.1907. PMID 10781355.
- ↑ Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R (2003). "Cardiac troponin I in acute pericarditis". J Am Coll Cardiol. 42 (12): 2144–8. doi:10.1016/j.jacc.2003.02.001. PMID 14680742.
- ↑ 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.
- ↑ 7.0 7.1 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.
- ↑ 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.
- ↑ 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.