title: Etiology of large pericardial effusions.
abstract: OBJECTIVE
  To determine the effectiveness of the preoperative evaluation and overall diagnostic efficacy of subxiphoid pericardial biopsy with fluid drainage in patients with new, large pericardial effusions.
  
  
  METHODS
  A prospective interventional case series of consecutive patients admitted with new, large pericardial effusions.
  
  
  METHODS
  Fifty-seven of 75 consecutive patients admitted to a university tertiary-care center and a university-affiliated Veterans Administration Medical Center with new, large pericardial effusions were studied over a 20-month period. Each patient was assessed by a comprehensive preoperative evaluation followed by subxiphoid pericardiotomy. The patients' tissue and fluid samples were studied pathologically and cultured for aerobic and anaerobic bacteria, fungi, mycobacteria, mycoplasmas, and viruses.
  
  
  RESULTS
  A diagnosis was made in 53 (93%) patients. The principle diagnoses consisted of malignancy in 13 (23%) patients; viral infection in 8 (14%) patients; radiation-induced inflammation in 8 (14%) patients; collagen-vascular disease in 7 (12%) patients; and uremia in 7 (12%) patients. No diagnosis was made in four (7%) patients. A variety of unexpected organisms were cultured from either pericardial fluid or tissue: cytomegalovirus (three), Mycoplasma pneumoniae (two), herpes simplex virus (one), Mycobacterium avium-intracellulare (one), and Mycobacterium chelonei (one). The pericardial fluid yielded a diagnosis in 15 (26%) patients, 11 of whom had malignant effusions. The examination of pericardial tissue was useful in the diagnosis of 13 (23%) patients, 8 of whom had an infectious agent cultured. Of the 57 patients undergoing surgery, the combined diagnostic yield from both fluid and tissue was 19 patients (33%).
  
  
  CONCLUSIONS
  A systematic preoperative evaluation in conjunction with fluid and tissue analysis following subxiphoid pericardiotomy yields a diagnosis in the majority of patients with large pericardial effusions. This approach may also result in the culturing of "unusual" infectious organisms from pericardial tissue and fluid.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: G R
authors.initials: GR
authors.lastname: Corey
authors.forename: P T
authors.initials: PT
authors.lastname: Campbell
authors.forename: P
authors.initials: P
authors.lastname: Van Trigt
authors.forename: R T
authors.initials: RT
authors.lastname: Kenney
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: K H
authors.initials: KH
authors.lastname: Sheikh
authors.forename: J A
authors.initials: JA
authors.lastname: Kisslo
authors.forename: T C
authors.initials: TC
authors.lastname: Wall
mesh_terms: D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D010496:Pericardium / Q000382:microbiology / Q000473:pathology*; D011300:Preoperative Care; D011446:Prospective Studies