title: The role of early contrast-enhanced chest computed tomography in the aetiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion.
abstract: OBJECTIVE
  The role of chest computed tomography (CT) is not well defined for either diagnosis or management of pericardial disease. The aim of this study was to evaluate the added value of early chest CT in the diagnostic workup for patients presenting with cardiac tamponade or large pericardial effusion of unknown aetiology as the first manifestation of disease.
  
  
  RESULTS
  We performed CT scan on 55 patients with pericardial effusion as defined above, undergoing echo-guided pericardiocentesis. We compared the success rate in making diagnosis and/or staging the underlying disorder of three sequential workups, including, respectively, (i) clinical presentation, inflammatory markers, chest X-ray imaging, (ii) all of the above and pericardial fluid analysis, and (iii) all of the above and chest CT. We were able to make diagnosis in 53 patients (96%): the major cause of effusion was malignancy (38%). Clinical and biochemical data were not able to differentiate non-tumour from tumour patients. CT revealed pathological findings in all patients with malignancy: tumour mass in 15/21 (71%) and pathological lymphadenopathy in the remaining 6 cases. The workup including CT provided a significantly higher diagnostic yield than the other two workups (P < 0.0001), both in the overall population and in the two subgroups of neoplastic (Npl) and non-Npl patients.
  
  
  CONCLUSIONS
  In all patients with cardiac tamponade or large pericardial effusion, CT was useful either in identifying the underlying disease or in excluding other potential causes of pericardial effusion. We conclude that chest CT is a very useful non-invasive diagnostic tool to identify and stage pericardial diseases.
authors.affiliation: Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy maggiolinistefano@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maggiolini
authors.affiliation: Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy.
authors.forename: Caterina C
authors.initials: CC
authors.lastname: De Carlini
authors.affiliation: Department of Cardiology, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Ferri
authors.affiliation: Laboratory of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milano, Italy.
authors.forename: Gualtiero I
authors.initials: GI
authors.lastname: Colombo
authors.affiliation: Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gentile
authors.affiliation: Department of Cardiology, San L. Mandic Hospital, Largo Mandic 1, Merate, Lecco 23807, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Meles
authors.affiliation: Department of Cardiology, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Riva
authors.affiliation: Department of Radiology, San L. Mandic Hospital, Merate, Lecco, Italy.
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Casella
authors.affiliation: Cardiology Department, Maria Vittoria Hospital and University of Torino, Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.affiliation: Division of Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D020519:Pericardiocentesis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media
keywords: Cardiac tamponade; Computed tomography; Echocardiography; Pericardial effusion; Pericardium