title: Association between parapneumonic effusion and pericardial effusion in a pediatric cohort.
abstract: OBJECTIVE
  Associations between pleural and pericardial effusions have been described in malignancy and autoimmune disorders. Bacterial pneumonia is the most frequent cause of parapneumonic effusion; however, knowledge of the relationship between parapneumonic effusion and the presence of pericardial fluid in children is limited. We examined this relationship.
  
  
  METHODS
  We performed a retrospective chart review of pediatric patients who were admitted to our institution during a 6-year period with a diagnosis of either parapneumonic effusion or empyema and who had undergone an echocardiogram, a computed tomography scan of the thorax, or both. All demographic, clinical, radiographic, and laboratory data of these patients were collected, and statistical analysis was done with Student's t tests and chi2 analyses.
  
  
  RESULTS
  We reviewed the charts of 59 children with parapneumonic effusions. Forty-eight underwent 2-dimensional echocardiography, chest computed tomography scan, or both. Of these 48 patients, 54.2% (n=26) were found to have a concomitant pericardial effusion. The majority of patients with pericardial effusions had left-sided pleural disease. Patients with pericardial effusions had more symptomatic days before hospitalization, lower pleural fluid albumin levels, elevated serum white blood cell counts, elevated pleural fluid white blood cell and absolute neutrophil counts, and an increased incidence of surgical intervention. One patient had evidence of hemodynamic compromise that required pericardiocentesis.
  
  
  CONCLUSIONS
  We found a high incidence of pericardial effusions in pediatric patients with parapneumonic effusions. Leukocytosis, higher pleural fluid leukocyte and neutrophil counts, and a propensity for surgical intervention suggest a prognostic relationship between pericardial effusions and more severe parapneumonic disease. The majority of these pericardial collections resolve with treatment of the underlying pleural disease.
authors.affiliation: Department of Pediatrics, Winthrop-University Hospital, 120 Mineola Blvd, Suite 210, Mineola, NY 11501, USA. jroberts@winthrop.org
authors.forename: Jon E
authors.initials: JE
authors.lastname: Roberts
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bezack
authors.forename: David I
authors.initials: DI
authors.lastname: Winger
authors.forename: Simcha
authors.initials: S
authors.lastname: Pollack
authors.forename: Rakesh A
authors.initials: RA
authors.lastname: Shah
authors.forename: Mary
authors.initials: M
authors.lastname: Cataletto
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Katz
authors.forename: Carlos
authors.initials: C
authors.lastname: Montoya-Iraheta
authors.forename: Scott A
authors.initials: SA
authors.lastname: Schroeder
authors.forename: Maria Lyn
authors.initials: ML
authors.lastname: Quintos-Alagheband
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004322:Drainage / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D020519:Pericardiocentesis / Q000379:methods; D010996:Pleural Effusion / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed