title: A structured, parsimonious approach to establish the cause of moderate-to-large pericardial effusion.
abstract: The workup of moderate-to-large pericardial effusion should focus on its hemodynamic impact and potential cause. A structured approach to diagnostic evaluation of pericardial effusion is needed. We retrospectively studied a contemporary cohort of 103 patients with moderate-to-large pericardial effusion hospitalized at St. Luke's Roosevelt Hospital Center from July 2009 till August 2013. Diagnosis of pericardial effusion was independently ascertained by chart review. We applied a stepwise parsimonious approach to establish the cause of pericardial effusion. In the studied cohort, the mean age was 61 years, 50% were men, and 65 patients (63%) underwent pericardial effusion drainage. Using the structured approach, the cause of the effusion was ascertained in 70 patients (68%) by noninvasive targeted testing. Malignant effusion was confirmed in 19 patients (19%). All patients with malignant effusion had either history of malignancy or suggestive noninvasive findings. In conclusion, a structured approach can help to ascertain the diagnosis in patients with moderate-to-large pericardial effusion and guide the need for pericardial drainage or sampling.
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York.
authors.forename: Vikram
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York.
authors.forename: Georges
authors.initials: G
authors.lastname: El Hayek
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chavez
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York.
authors.forename: Jose Ricardo
authors.initials: JR
authors.lastname: Po
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York.
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.affiliation: Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Health System, New York, New York. Electronic address: eargulian@chpnet.org.
authors.forename: Edgar
authors.initials: E
authors.lastname: Argulian
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D020519:Pericardiocentesis / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index