[Emergency sonographic diagnosis. 2: Blunt abdominal trauma, aortic aneurysms, pleural effusion, pericardial effusion].
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Abdominal Injuries↗
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Symptomatic pericardial effusion: pericardial drainage and localized steroid instillations as definitive therapy.
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Administration, Topical↗
Intrapericardial treatment of neoplastic pericardial effusions.
Pericardial effusion and cardiac tamponade are known complications of many advanced malignancies as lung cancer, breast cancer, lymphomas and leukemias. Initial relief can be easily obtained with percutaneous echo-guided pericardiocentesis, without significant mortality and morbidity and well-tolerated even in critically ill patients. Effusion recurrences can be observed, however, in up to 40% of cases if only simple pericardial drainage is performed. Effective management can be obtained by instillation in the pericardial sac of different agents, with sclerosing or cytostatic activity, like tetracyclines, bleomycin, thiotepa or radionuclides. Intrapericardial sclerotherapy is associated to good results in terms of recurrence prevention and survival improvement. Absence of pericardial effusion at 30 days after drainage can be observed in 70 to 90% of all treated patients, without significant variations among different treatments. No significant side effects are observed, with the exclusion of chest pain during tetracyclines instillation. In our opinion pericardiocentesis associated to intrapericardial sclerotherapy with thiotepa is the best compromise in terms of recurrence prevention, tolerability and costs. Real randomized, case-control studies are moreover required to assess the gold standard of malignant pericardial effusions treatment.
Antineoplastic Agents↗
The usefulness of a panel of immunostains in the diagnosis and differentiation of metastatic malignancies in pericardial effusions.
Pericardial effusions are not uncommon in patients with an advanced malignancy Rarely malignancies may present initially with a pericardial effusion. Cytological examination of pericardial fluid may be valuable in differentiation of these cases. However, a metastatic tumour in serous effusion may not always show the functional differentiation of the primary tumour. In such a situation, although a wide range of special studies have been suggested for the diagnosis of malignancy we have found the use of a panel of a few common immunostains to be useful in confirming or suggesting the site of a primary tumour. The material for this study consisted of 76 pericardial fluids obtained between January 1991 and October 1998 from 46 males (mean age 59 years) and 30 females (mean age 52 years). Metastatic malignancy was diagnosed in 22 of the 76 patients and in 7/22 cases pericardial effusions were the initial presentation. The subsequent follow-up in the seven cases revealed adenocarcinoma of lung (n = 2), small cell anaplastic carcinoma of lung (n = 1), squamous cell carcinoma lung (n = 1), melanoma leg (n = 1), non-Hodgkin's lymphoma retroperitoneal lymph nodes (n = 1) and carcinoma of the breast (n = 1). Of the remaining 15 cases with a known history of malignancy, eight had cancers (three adeno; two small cell; one poorly differentiated, and two squamous cell types) of the lung; breast (n = 3); colon (n = 1); melanoma (n = 2) and non Hodgkin's lymphoma (n = 1). Immunostains which were useful in the diagnosis were EMA, CEA, cytokeratin, B72.3, HMB45, vimentin, S100, LCA, L26 and kappa and lambda light chains.
Adenocarcinoma↗
Diagnosis and management of pericardial effusions.
Pericardial effusions are a relatively common phenomenon, largely in part due to its many possible etiologies. Although a considerable amount of cases are idiopathic, careful history and physical examination will reveal the etiology in a vast majority of patients. The most effective tools, echocardiography and right heart catheterization, should be aimed not only at the diagnosis of the pericardial effusion, but also to the assessment of the severity of the pericardial effusion, since this will determine that individual patient's management. A small, asymptomatic pleural effusion of known etiology can be treated conservatively, mostly by treating the underlying cause and with careful observation for signs or symptoms of deterioration. Large effusions can be treated with closed pericardiocentesis after routine evaluation for possible etiologies. For patients presenting actual or impending tamponade, the definitive treatment is either closed or open pericardiocentesis, depending on fluid accumulation characteristics, and it should not be delayed for the administration of medical treatment (inotropes, intravenous fluids). Routine evaluation of pericardial fluid is warranted in those cases in which a clear etiology was not established prior to pericardiocentesis.
Echocardiography↗
Respiratory effects on systolic time intervals during pericardial effusion.
Pericardial effusion without cardiac tamponade is defined by the detection of excessive pericardial fluid without clinical manifestations, particularly pulsus paradoxus (inspiratory decrease in systolic blood pressure greater than 10 mm Hg) and jugular venous distention. Nineteen consecutive patients without heart or lung disease who had pericardial findings and no evidence of tamponade were investigated by echocardiography: 14 with pericardial effusion and 5 with noneffusive ("dry") pericarditis. Patients with effusion had an inspiratory decrease in left ventricular ejection time (delta LVET) of 17.9 +/- 5.78 ms and an increase in preejection period (delta PEP) of 12.1 +/- 3.78 ms, each well beyond the respective respiratory changes measured in normal subjects. The 5 control patients with dry pericarditis had a mean delta LVET and delta PEP of only 8.0 and 7.0 ms, respectively. Of the 14 patients with effusion, 6 whose systolic pressure showed no respiratory change had mean delta LVET of 13.7 ms and delta PEP of 11.2 ms, comparable to the other 8 patients with effusion who had a respiratory change of 2 to 10 mm Hg. We conclude that although pulsus paradoxus was not present, excessive pericardial fluid is not physiologically inert. If a satisfactory echocardiogram is not available, exaggerated respiratory fluctuation in systolic time intervals may be evidence of excessive pericardial fluid.
Blood Pressure↗
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↗
Large Pericardial Effusions.
Pericardial effusions accompany a number of clinical conditions. The challenges facing the clinician when dealing with a pericardial effusion include assessing the urgency of draining the effusion, choosing the right approach for drainage, determining the mechanics of the effusion, and establishing a cause for the effusion. Currently available diagnostic methods, echocardiographic modalities in particular, greatly aid in the diagnostic assessment as well as in carrying out appropriate therapeutic strategies.
Journal Article↗
[Carcinomatous pericarditis monitored by pulsed Doppler echocardiography of superior vena cava: hemodynamics from pericardial effusion to pericardial solid invasion].
We utilized pulsed Doppler echocardiography to monitor changes in a patient with carcinomatous pericarditis, from pericardial effusion with cardiac tamponade to pericardial solid invasion. Characteristic changes in superior vena cava (SVC) pulsed Doppler flow patterns were observed after invasion of the pericardium. SVC pulsed Doppler flow patterns are a useful aid in differentiating between solid invasions and recurrent pericardial effusion with pericardial thickening: this diagnostic capability is not readily available with computed tomography.
Adenocarcinoma↗
[Treatment of neoplastic pericardial effusions].
Pericardial effusion is a known complication of many advanced malignancies, with strong impact both on quality of life and prognosis. The initial and easier relief can be obtained through percutaneous pericardiocentesis, echo- or fluoro-guided. However, effusion recurrences can be observed in up to 40% of cases. Effective management can be obtained by more invasive approaches like percutaneous or surgical creation of pericardial windows but the more cost-effective procedure is pericardiocentesis followed by intrapericardial instillation of sclerosing or cytostatic agents like tetracyclines, bleomycin, cisplatin and thiotepa. No significant local or systemic side effects are reported, except for chest pain during tetracyclines instillation. No recurrences at 30 days are observed in 80%-90% of patients, according to different series and, particularly, to different malignancies. No evidence-based data are in fact available to assess the "gold standard" and the best therapeutical approach for the single patient.
Antineoplastic Combined Chemotherapy Protocols↗
[Pericardial puncture under the ultrasonic cardiotomographic guidance: application to pericardial effusion].
Pericardial puncture drainage was attempted in five patients with pericardial effusion under the guidance of real time two-dimensional echocardiography (ultrasonic cardiotomography). The needle fixed to the scanner probe was inserted from the anterior chest wall under the observation of ultrasound images. After the needle was placed into the pericardial space, then the drainage catheter was introduced according to the Seldinger technique. The image of the needle should be appropriately monitored from the site of puncture as near as possible because the pericardium is so close to the anterior chest wall. Both mechanical and linear sector scanners were used in this study, and linear type was proved to be useful for this purpose. It was concluded that the pericardial puncture under the guidance of ultrasonic cardiotomography is safer and reliable compared to the conventional blind puncture technique.
Adult↗
Characterization of IL-2-activated TILs and their use in intrapericardial immunotherapy in malignant pericardial effusion.
Pericardial effusion (PE) and cardiac tamponade caused by malignant pericarditis are critical conditions in cancer patients, which still lack a recommended protocol for their long-term management. Percutaneous pericardiocentesis and simple drainage are commonly performed as the initial treatment. The aims of this study were to investigate the presence of cytotoxic T lymphocytes (CTLs) in malignant PE and to determine the clinical response to administering autologous tumor-infiltrating lymphocytes (TILs) into the pericardial cavity. Initially, we identified human lymphocyte antigen class-I-restricted and tumor-specific CTLs within the interleukin-2 (IL-2)-activated TILs in PEs from four patients, on the basis of interferon-gamma production and lactate dehydrogenase-release assays. Clinically we observed favorable responses to the pericardial transfer of IL-2-activated autologous TILs in four patients: one male with advanced esophageal cancer, one female with recurrent lung cancer and two females with recurrent breast cancer, respectively. Autologous TILs from PEs were expanded in vitro with IL-2, characterized for CD3, CD4 and CD8 markers, checked for contamination and then infused into the patient's pericardial space through a catheter. This was repeated biweekly. After treatment, there were no signs of recurrence of PE in either case, as determined by radiography, echocardiography and computed tomography. The only adverse effects seen were grade 1 fevers. These results suggested that intrapericardial cellular immunotherapy with autologous TILs could be a safe and effective treatment for controlling malignant pericarditis with associated cardiac tamponade, and that tumor-specific CTLs present in malignant PE might be important for tumor rejection.
Aged↗
[No consequences of prolonged drainage following open heart surgery on the incidence of postoperative pericardial effusion].
Pericardial effusion (PE) frequently occurs after cardiac surgery and, in some cases, complicates the postoperative course. This study was performed in order to assess if prolongation of the postoperative drainage period may result in a decreased incidence of PE. For this purpose we studied 100 patients, randomised into two groups. In group I (50 patients) standard drainage of the thorax was performed. In group II (50 patients) the drainage period was prolonged by 24 hours. The amount of fluid drained during the additional period did not correlate with preceding fluid production. Echocardiography performed on the sixth postoperative day revealed a virtually equal incidence of PE in both groups: 26 patients in group I, 29 patients in group II. None of the observed effusions resulted in clinical signs of cardiac tamponade. PE occurred more frequently in patients with more than 60 ml of additional drainage volume (p less than 0.01). We conclude that: (1) prolonging the duration of postoperative drainage does not result in a lower incidence of postoperative PE and (2) the aetiological process causing PE in a number of patients is probably already active during the early postoperative course.
Adult↗
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↗
Pericardial effusion and pericardial compartments after open heart surgery. An analysis by computed tomography and echocardiography.
Thirty-three patients with pericardial effusion after open heart surgery were investigated with computed tomography (CT). Twelve of the 33 patients also underwent echocardiography prior to pericardiocentesis. The effusions were typed according to the results of the CT investigation. Because of postoperative adhesions, typical patterns of localized pericardial effusions were found in 16 patients. The localized compartments were seen on the right and left side of the heart and around the aorta and the pulmonary artery. CT was therefore shown to be of value for selecting the approach for drainage with catheter pericardiocentesis.
Adult↗
Hemorrhagic pericardial effusion causing pericardial tamponade in hereditary hemorrhagic telangiectasia.
Osler-Weber-Rendu disease, or Hereditary Hemorrhagic Telangiectasia (HHT), is a rare, inherited autosomal dominant disorder characterized by telangiectasia and arteriovenous malformations in various organs. We report a unique case of HHT-associated hemorrhagic pericardial effusion presenting with pericardial tamponade.
Aged↗
[CT-guided percutaneous puncture and drainage of pericardial effusion].
Pericardial fluid can impair cardiac function. If medication is ineffective, puncture and drainage of the fluid is necessary. Three cases of CT-guided puncture and drainage of pericardial fluid are reported. The described technique is quick, of little risk and effective. It is superior to the conventional puncture of the pericardium from the subxiphoidal direction.
Drainage↗
[Personal experience with the treatment of pericardial effusion using pericardial fenestration].
The author discusses experience with treatment of pericardial exudates of different aetiology in 11 patients aged 5-54 years. In seven patients they performed fenestration and external drainage of the pericardial cavity from a subxyphoid approach and in four by a pleurocardial window from left-sided thoracotomy. They did not record any per or postoperative complications or deaths. The best surgical approach, in particular in patients with a pericardial exudate and a poor general condition is pericardial fenestration with external drainage from a subxyphoid approach.
Adolescent↗