Etiologic Pattern, Severity, and Outcome of Pericardial Effusion Among Children Seen Over Ten Years at a Tertiary Hospital in Sokoto, Northwest Nigeria

Abstract

Introduction: Pericardial effusion (PE) is an abnormal accumulation of fluid in the pericardial space, which, if severe, is associated with high mortality. The causes are diverse, including infective and non-infective. Few studies have looked at the spectrum of severity and causes in Northern Nigeria. The aim was to determine the spectrum of causes and severity of pericardial effusion, as well as the outcome among children seen at the Paediatric Cardiology Unit, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Methods: This ten-year retrospective study reviewed the echocardiographic and admission records of children admitted to the Pediatric Cardiology unit, UDUTH, Sokoto, from January 2014 to December 2023. Data on age, gender presentation, diagnosed causes, and outcomes were extracted and entered into a study pro forma. Results: Cases with pericardial effusion were 121. Of these, 79 (65.3%) were male and 42 (34.7%) were female (M:F = 1.9:1). The mean age of all cases was 8.2±4.3 years, and 72% (87/121) were aged 5 years or older. Eighteen (14.8%) had severe effusion and cardiac tamponade, 42 (34.7%) had moderate effusion, and 61 (50.4%) had mild effusion. Infective causes were 91 (75.2%) and included rheumatic heart disease (30/121, 24.8%), tuberculosis (28/121, 23.1%), and dilated cardiomyopathy (15/121, 12.4%), while non-infective causes were 30 (24.8%) and included congenital heart disease (14/121, 11.6%), pulmonary hypertension (7/121, 5.8%), and connective tissue diseases (4/121, 3.3%). Five had open tube pericardiostomy, and 10 had percutaneous echo-guided drainage. Two cases with sepsis were positive for microbial growth, and two cases of tuberculous effusion had chronic inflammation on pericardial biopsy. Outcomes differed by underlying cause, with mortalities mainly from rheumatic heart disease and dilated cardiomyopathy. Conclusion: In the study area, preventable infective causes of pericardial effusion predominated with higher mortality. Males and older children had more severe effusions. More efforts at prevention would be beneficial in this regard.