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Etiology and danger of pericardial effusion in infants and children

Published online by Cambridge University Press:  19 August 2008

Hani Zreik ,
Jennifer Li  and
Arthur T. Garson Jr
Hani Zreik*
Affiliation:
Division of Pediatric Cardiology, Duke University Medical Center, Durham
Jennifer Li
Affiliation:
Division of Pediatric Cardiology, Duke University Medical Center, Durham
Arthur T. Garson Jr
Affiliation:
Division of Pediatric Cardiology, Duke University Medical Center, Durham
*
Dr. Hani Zreik, St Lukes Hospital, Division of Pediatric Cardiology, 800 Cooper Avenue. Suite 2, Saginaw, MI 48602, USA. Tel. 517-752-8669.
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Summary

Pericardial effusion requires attention because of its underlying pathology and its potential for producing hemodynamic compromise. It was our hypothesis that the etiology of and danger from large pericardial effusions are different at different ages. We reviewed the clinical data on 44 consecutive patients seen between 1986 and 1993. All (age range 0-19 years) had a large pericardial effusion identified by echocardiography, and 38 had fluid available for analysis, pericardiocentesis in these cases being undertaken on the basis of the clinical decision of the attending physician. History, physical examination, chest x-ray, electrocardiogram, and echocardiographic Doppler findings were evaluated retrospectively. Of the patients, 17 presented with tamponade. Of the 14 patients aged less than one year, 12 had tamponade (85%), whereas in the 30 patients older than one year, only five (16%) had tamponade. Surgical drainage was needed in seven patients. Typical physical and electrocardiographic findings (distant heart sounds, pericardial friction rub, decreased QRS voltage, and ST-T wave abnormalities) were present in less than half the patients. Etiologies of the effusion included infection in 10 (four less than one year old, and six greater than one year of age). Among these, two unusual pathogens were detected: Mycobacterium avium-intracellulaire and Candida tropicalis. In eight patients, the effusion was due to trauma (six less than one year old, and two older than one year), and in 11 it was due to post-pericardiotomy syndrome (two less than one year of age and nine older than one year). Malignancy was the cause in six (all older than one year of age), radiation in two, and collagen vascular disease, drug induced, and uremia in one each, all older than one year. Only three patients had idiopathic effusions (6%). These data suggest that, unlike adults, an etiologycan be found in most children with large pericardial effusions. Those less than one year of age are much more likely to present in cardiac tamponade.

Keywords

Pericardial effusioncardiac tamponade
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 2 , April 1996 , pp. 162 - 165
Copyright
Copyright © Cambridge University Press 1996

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References

1.Levine, MJ, Lorell, BH, Diver, DJ, Come, PC. Implications of echocardiographically assisted diagnosis of pericardial tamponade in contemporary medical patients: detection before hemodynamic embarrassment. J Am Coll Cardiol 1991; 17:59–65.CrossRefGoogle ScholarPubMed
2.Fast, J, Wielenga, RP, Jansen, E, Schurmans Stekhoven, JH. Abnormal wall movements of the right ventricle and both atria in patients with pericardial effusion as indicators of cardiac tamponade. Eur Heart J 1986; 7: 431–436.CrossRefGoogle ScholarPubMed
3.Eisenberg, MJ, Oken, K. Prognostic value of echocardiography in hospitalized patients with pericardial effusion. Am J Cardiol 1994; 70: 934–939.CrossRefGoogle Scholar
4.Colombo, A, Olson, HG, Egan, J. Etiology and prognostic implications of a large pericardial effusion in men. Clin Cardiol 1988; 11: 389–394.CrossRefGoogle ScholarPubMed
5.Permanger-Murielda, G, Sagrista-Sauleda, J. Primary acute pericardial disease: a prospective study of 231 consecutive patients. Am J Cardiol 1985; 56: 623–630.CrossRefGoogle Scholar
6.Lorell, BH, Braunwald, E. Pericardial disease. In: Braunwald, E. (ed). Heart Disease. WB Saunders, Philadelphia, 1988, pp 1465–1516.Google Scholar
7.Savoia, MC, Oxman, MN. Myocarditis, pericarditis and mediastinitis. In: Mandel, GL, Douglas, RG (eds). Principles and Practice of Infectious Diseases. Third edition. Churchill Livingstone, New York, 1990, pp 721–727.Google Scholar
8.Engle, MA, Zabriskie, JB, Senterfit, LB, Gay, WA Jr, O’Loughlin, JE Jr, Ehlers, KH. Viral illness and the postpericardiotomy syndrome. A prospective study in children. Circulation 1980; 62: 1151–1158.CrossRefGoogle ScholarPubMed