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Results for “Pericardial Effusion”

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PubMedDate not supplied

The use of cytology to evaluate pericardial effusions.

Pericardial effusions from 27 patients were examined cytologically during the five-year period of 1973-1977. Malignant cells were found in eight cases (30 percent). In three of these patients malignancy was unsuspected clinically, and this was the first time the cancer was diagnosed. In addition, cytology often suggested the specific histological types and possible primary sites to be determined. Special stains were also found helpful. There were no false positive reports. Although the pericardial effusions from the remaining 19 patients were negative for tumor cells, metastatic carcinoma to the pericardium was discovered at autopsy in two of these cases. Thus, cytologic examination of pericardial fluid is an important tool in the diagnosis of malignancy, but false negative results may occur.

Adenocarcinoma↗

PubMed1977

Echocardiographic detection of pericardial effusion and pericardial thickening in malignant lymphoma.

Serial echocardiographic examinations of the heart were obtained for 13 patients undergoing irradiation for malignant lymphoma. Eleven of these had been shown to have mediastinal adenopathy; none had clinically detectable pericardial disease. The pericardial effusion which had been echocardiographically evident in 6 patients prior to treatment disappeared during or subsequent to the course of radiotherapy. Small asymptomatic effusions appeared in 5 patients during the follow-up period. Pericardial effusions, detected easily by echocardiography, occur more commonly than hed been previously thought in patients with malignant lymphoma.

Adolescent↗

PubMed1977

Clinically silent pericardial effusions in patients on long-term hemodialysis. Pericardial effusions in hemodialysis.

The danger of cardiac tamponade occurring when pericarditis is accompanied by pericardial effusion, as opposed merely to the presence of a friction rub without effusion, has been unclear. Forty patients on hemodialysis were studied by physical examination, chest x-ray film, and echocardiography for evidence of pericarditis and pericardial effusion. Only two patients developed a friction rub during the study and were placed on regional heparin. Ten of 11 patients who were positive on echocardiogram for pericardial effusion had unremarkable physical examinations. These 11 patients had cardiomegaly as noted on chest x-ray examination. Eighteen of 25 patients without effusion also had cardiomegaly on chest x-ray film. No patient remaining on systemic heparin and having a pericardial effusion developed cardiovascular complications during hemodialysis. This study suggests that while many patients on longterm hemodialysis have pericardial effusion undiagnosed on the basis of physical examination, but noted on echocardiogram, special precautions to prevent tamponade during hemodialysis are not necessary. Also, posterior-anterior chest x-ray film showing a normal-sized heart will usually exclude significant pericardial effusion.

Cardiac Tamponade↗

PubMed1978

Recurrent cardiac tamponade and large pericardial effusions: management with an indwelling pericardial catheter.

A new technique, using an atraumatic indwelling catheter, has been developed for short-term management of large or rapidly reaccumulating pericardial effusions. This technique (1) permits continuous pericardial fluid drainage, obviating repeated aspirations; (2) provides a convenient route for intrapericardial instillation of chemotherapeutic agents; and (3) enables one to await the results of diagnostic studies without subjecting a patient to thoracotomy. Experience in three patients suggests that in some cases the use of this catheter may eliminate the need for surgery; in others, it may serve as a valuable temporary measure to achieve stabilization of the patient's condition.

Cardiac Catheterization↗

PubMed1978

Mechanism of electrical alternans in patients with pericardial effusion.

Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomonon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cadiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.

Adenocarcinoma↗

PubMed1975

Echocardiographic evaluation of pericardial effusion in myxedema. Incidence and biochemical and clinical correlations.

Pericardial effusion is a recognized consequences of myxedema. Its incidence is unknown, primarily because of past difficulties in establishing the diagnosis. We studied 33 hypothyroid patients by echocardiography. Ten of the 33 patients (30%) had positive echoes for pericardial effusion. Seven of these ten patients had enlarged hearts on chest X-ray. Five patients had cardiac enlargement but no echo evidence of pericardial effusion. Serum concentrations of thyroxine, 1.8+/-0.3 vs 1.5+/-0.1 mcg/dl and of thyroid stimulating hormone, 34+/-4 vs 38+/-5 muU/ml did not differ in the groups with and without pericardial effusion, respectively. However, the pericardial effusion group had significantly slower heart rates on ECG than those without pericardial effusion: 53+/-8 vs 68+/-2 beats/min, P less than 0.05. Low voltage was present in five of the ten patients with pericardial effusion and five of the 23 nonpericardial effusion patients. None of the patients with pericardial effusion developed tamponade. Seven patients with pericardial effusion were restudied after periods of thyroxine replacement therapy ranging from six months to two years. All were euthyroid and had negative echoes on follow-up, but two still showed cardiomegaly on chest X-ray (both had associated coronary artery disease). We conclude that pericardial effusion occurs frequently in patients with myxedema. Tamponade is uncommon and the effusions disappear with thyroid replacement therapy. Cardiomegaly on chest X-ray and low voltage on ECG are not reliable indicators of pericardial effusion.

Cardiomegaly↗

PubMed1979

Two-dimensional echocardiography and B-mode ultrasonography for the diagnosis of loculated pericardial effusion.

Two cases of loculated pericardial effusion resulting in cardiac tamponade are presented. The loculated nature and extent of the effusion was best defined by two-dimensional echocardiography or B- mode ultrasonography. Cross-sectional images should probably be obtained in all cases of suspected loculated pericardial effusion and in patients in whom the interpretation of the M-mode echocardiogram is equivocal as to the presence or absence of pericardial effusion.

Adult↗

PubMed1975

Radiation-related pericardial effusions in patients with Hodgkin's disease.

Pericardial effusions following radiotherapy for Hodgkins Disease have previously been described as infrequent and related to the total dose of radiation received. Analysis of all chest x-rays on 81 patients who received upper-mantle radiotherapy for Hodgkins Disease at the Baltimore Cancer Research Center between 1968 and 1972 disclosed an incidence of pericardial effusions of 30.9% (25 of 81), with 13.6% (11 of 81) requiring limitation of activity (5) or pericardiectomy (6). Clinical presentation of radiation-related percardial effusions was subtle, with signs and symptoms a late finding if they occurred. Radiotherapy data was reviewed and no difference in total dose (rads) or time-dose relationships (rets) was found between the groups who did or did not develop effusions. Analysis of multiple pre-treatment clinical and pathological characteristics disclosed four parameters that were felt to be related to the development of pericardial effusions; elevated ESR, normal absolute lymphocyte count, initial presence of extensive mediastinal adenopathy and the addition of adjuvant chemotherapy. The presence of increasing combinations of these pretreatment 'risk factors' led to an increasing likelihood of developing a radiation-related pericardial effusion such that six of seven patients with all four 'risk factors' developed a pericardial effusion. Nine of 13 clinically significant effusions were associated with the addition of adjuvant chemotherapy. Possible pathogenetic mechanisms that include factors other than radiation dosage and the clinical management of radiation-related pericardial effusions are discussed.

Adult↗

PubMed1976

[Diagnosis and differential diagnosis of pericardial effusion].

The clinical, hemodynamic and radiologic signs of pericardial effusion are reviewed. From the symptomatic point of view low pressure (lax) pericardial effusion and compressive effusion (tamponade) are to be distinguished. Echocardiography is today the preferred method for study of patients with suspected pericardial effusion. This technique also provides insight into ventricular performance and is therefore helpful in the differential diagnosis of cardiomegaly due to pericardial effusion, heart failure or both. In our material uremic pericarditis, malignant tumors and leukemia were the predominant causes of pericardial effusion.

Adult↗

PubMed1978

Demonstration of pericardial effusion by real-time ultrasonography.

Pericardial effusion has a variety of causes. Among these, inflammatory processes are the most common. Traditionally x-rays, isotopic scanning, carbon dioxide injection, and M-mode echocardiography have been used for evaluation of pericardial effusion. The most recent advance in real time scanning enables the examiner to more completely and more accurately evaluate and serially investigate pericardial effusions through a noninvasive technique.

Echocardiography↗

PubMed1977

Reliability of echocardiography in quantitating pericardial effusion: a prospective study.

A method of estimating the volume of pericardial effusion by echocardiography has used the difference between the cubed diameters at end-diastole of the pericardium and epicardium. To evaluate the reliability of this technique in quantitating the volume of pericardial effusion in a prospective study, 22 echocardiograms were obtained in six patients before and after 11 separate pericardiocenteses. The correlation coefficient between the actual volume of aspirated pericardial effusion and the echocardiographically estimated volume of aspirated pericardial effusion was r = 0.27 (P not significant). The volume of pericardial effusion aspirated was overestimated or underestimated by echocardiography by more than 100 ml in seven of 11 estimations (64 percent) and by more than 150 ml in five of 11 estimations (45 percent). Therefore, although echocardiography is the procedure of choice in diagnosing the presence of pericardial effusion, it is not an entirely accurate method of quantitating the volume of pericardial effusion. However, echocardiography can differentiate a large effusion from a moderate or small effusion.

Adult↗

PubMed1978

Echocardiographic interpretation of pericardial effusion.

Echocardiography has proved to be quite useful in the detection of pericardial effusion. As little as 15 ml of fluid within the pericardial space can be detected. Specific signs of pericardial effusion, such as electrical alternans and paradoxical pulse, have become better understood by echocardiographic study. Yet, with all the benefits of echocardiography, the detection of pericardial effusion still may be quite difficult if careful attention is not given to technique. False-positive diagnosis of anterior pericardial effusion can be seen with epicardial fat pad, pericardial cyst, or foramen of Morgagni hernia. False-positive posterior pericardial effusion can be seen in large left pleural effusion, calcified mitral anulus, or excessively medial transducer angulation. New "switched-gain" circuits have helped detection of pericardial effusion by enhancement of pericardial echoes.

Echocardiography↗

PubMed1977

The subxiphoid approach in the treatment of pericardial effusion.

Subxiphoid pericardiotomy for diagnosis and treatment of pericardial effusion is a safe procedure. Not only does it appear to be safer than aspiration, but it yields more information because of its ability to obtain pericardial tissue. The recurrence rate of pericardial effusion is lower using subxiphoid pericardiotomy. For these reasons it is the technique of choice for diagnosis and treatment of nontraumatic pericardial effusion.

Drainage↗

PubMed1976

Uremic pericardial effusion. Treatment by catheter drainage and local nonabsorbable steroid administration.

Pericardial drainage via percutaneous catheter placement and local nonabsorbable steroid instillation was employed as definitive therapy for uremic patients who had intractable pericardial effusions. Twelve patients are reported. Prior daily dialysis, and in one case systemic steroids, were not curative. 11 of 12 cases suffered severe tamponade requiring pericardiocentesis. One patient had an organized pericardial effusion, making pericardiocentesis impossible. He required pericardiectomy with prolonged hospitalization (2 weeks) due to postoperative complications. There were no complications in the 11 patients where catheter drainage and local steroid instillation were employed. No patient had recurrence of his pericardial effusion (followed from 2 weeks to 32 months). Instillation of a relatively nonabsorbable steroid through an indwelling pericardial catheter provides immediate and lasting relief without either the inconvenience or postoperative complications and prolonged hospitalization associated with the surgical procedure of pericardial fenestration. This report offers initial evidence that the percutaneous approach may be a safe and effective alternative to pericardial fenestration in most uremic patients with pericardial effusion.

Cardiac Catheterization↗

PubMed1979

Myocardial accumulation of labeled phosphate in malignant pericardial effusion.

Recognition of the presence of a malignant pericardial effusion is important because of the insidious onset and life-threatening potential. This report presents data on three patients with metastasizing carcinoma of the breast, all admitted with a presumptive clinical diagnosis of malignant pericardial effusion. Two of the three revealed a diffuse concentration of Tc-99m PPi within the myocardium. In these cases the diagnosis was confirmed by identification of malignant cells in the pericardial fluid. We suggest that the use of labeled phosphate agents may allow early recognition of myocardial involvement in patients with disseminated neoplasm that results in malignant pericardial effusion.

Aged↗

PubMed1979

Echocardiographic incidence of pericardial effusion in patients resuscitated by emergency medical technicians.

The incidence of echocardiographically determined pericardial effusion was assessed in the early postmanual cardiopulmonary resuscitation (CPR) period in a group of patients resuscitated by advanced emergency medical technicians (EMT-P) from the Rescue Division of the Tampa Fire Department. The survival rate from out-of-hospital sudden death is comparable to that reported in other series. Twenty-six survivors of out-of-hospital sudden death had echocardiograms performed an average of 2.5 days (range 0-10) postCPR to determine the amount of pericardial effusion. Eight of the 26 (31%) patients had received intracardiac drugs during CPR administered by the EMT-Ps when physician-directed by radio. Of the 26, three (12%) were found to have very minimal pericardial effusions; all deemed insignificant. All three had alternate explanations for physiological or pathological causes of their effusions. One had received intracardiac drugs, but the pericardial effusion could be explained by congestive cardiomyopathy. Another had congestive cardiomyopathy, and the third had sustained a severe steering wheel injury to the chest. Thus, manual CPR with or without the use of intracardiac drugs does not appear to cause significant pericardial effusions in survivors of sudden cardiac death.

Adult↗

PubMed1979

Electrocardiographic voltage in pericardial effusion.

The usefulness of the electrocardiographic sign of "low voltage" in the diagnosis of pericardial effusion was investigated in 122 patients comprising three study groups. Sixty-four patients (group 1) had a pericardial effusion detected and measured by echocardiographic studies. The volume of the effusion showed no correlation with electrocardiographic voltage. A second group of 36 patients was identified as having low voltage on routine electrocardiograms. Only 13 (36 percent) had echocardiographically demonstrable pericardial effusion. Group 3 consisted of 22 patients who required pericardiocentesis. The ECGs obtained immediately after pericardiocentesis showed an increase in average voltage of 0.48 mm in the limb leads and 0.83 mm in the precordial leads for each 100 ml of fluid removed. This study demonstrates that a single ECG with "low voltage" is not useful in the diagnosis of pericardial effusion but that a reduction in the voltage of serial ECGs may suggest the development of pericardial effusion.

Echocardiography↗

PubMed1977

Potential pitfalls in quantification of pericardial effusions by echocardiography.

In the echocardiographic assessment of patients with pericardial effusions, the apparent width of the echo-free space between the left ventricular posterior wall and the parietal pericardium is commonly used to estimate the amount of pericardial fluid present. In 4 patients with pericardial effusions, we showed a distinct disparity between the widths of the posterior pericardial space at different levels of the left ventricular posterior wall. In 2 of them, a 'swinging heart' appearance was recorded when the ultrasoound beam was directed caudally, but not when its direction was cephalad or less caudad. It is suggested that the left ventricle should be scanned at all possible sites to minimise potential errors in estimating the amount of a pericardial effusion.

Adult↗