title: Etiologic diagnosis of 204 pericardial effusions.
abstract: The etiologic evaluation of pericardial effusion is frequently unsuccessful when noninvasive methods are used. To determine the cause of the current episode, all patients with echographically identified pericardial effusion from May 1998 to December 2002 underwent noninvasive diagnostic testing of blood, throat, and stool samples. Patients with postpericardiotomy syndrome were excluded. To analyze the value of our tests, we tested randomly selected blood donors as negative controls. Among 204 included patients, 107 (52.4%) had a final etiologic diagnosis: the etiology of 52 was highly suspected at first examination and later confirmed (thyroid deficiency, 5 cases; systemic lupus erythematous, 7; rheumatoid arthritis, 7; scleroderma, 3; cancer, 25; and renal insufficiency, 5). A definite etiologic diagnosis was made in 11 patients from pericardial fluid analysis (cancer, 5 cases; tuberculosis, 3; Streptococcus pneumoniae, Citrobacter freundii, and Actinomyces, 1 case each). Among 141 patients considered to have idiopathic pericarditis, 44 (32.1%) gained an etiologic diagnosis by our systematic testing strategy. This included serologic evaluation of serum (Coxiella burnetii, 10 cases; Bartonella quintana, 1; Legionella pneumophila, 1; Mycoplasma pneumoniae, 4; influenza virus, 1), viral culture of throat swabs (enterovirus, 8 cases; and adenovirus, 1), high-level antinuclear antibodies (>1/400, 3 cases), and thyroid-stimulating hormone (15 abnormal results). Antibodies to Toxoplasma and cytomegalovirus, enterovirus recovered from rectal swabs, and low-level antinuclear antibodies were seen with equal frequency in patients and controls. Using our evaluation strategy, the number of pericardial effusions classified as idiopathic was less than in other series. Systematic testing for Q fever, Mycoplasma pneumoniae, thyroid abnormalities, and antinuclear antibodies, accompanied by viral throat cultures, frequently enabled us to diagnose diseases not initially suspected in patients with pericardial effusion.
authors.affiliation: Unité des Rickettsies, Université de la Méditerranée, Marseille, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Levy
authors.forename: Ralf
authors.initials: R
authors.lastname: Corey
authors.forename: Pierre
authors.initials: P
authors.lastname: Berger
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
authors.forename: Samuel
authors.initials: S
authors.lastname: Levy
authors.forename: Thierry
authors.initials: T
authors.lastname: Messana
authors.forename: Pierre
authors.initials: P
authors.lastname: Djiane
authors.forename: Yves
authors.initials: Y
authors.lastname: Frances
authors.forename: Celine
authors.initials: C
authors.lastname: Botta
authors.forename: Philippe
authors.initials: P
authors.lastname: DeMicco
authors.forename: Henri
authors.initials: H
authors.lastname: Dumon
authors.forename: Olivier
authors.initials: O
authors.lastname: Mundler
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Chomel
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications; D001424:Bacterial Infections / Q000175:diagnosis; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010490:Pericardial Effusion / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D010493:Pericarditis / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications; D012595:Scleroderma, Systemic / Q000150:complications; D011795:Surveys and Questionnaires; D014777:Virus Diseases / Q000175:diagnosis