‘Idiopathic’ pericarditis - the clinician's challenge [nothing is idiopathic]

Abstract

Reports on the aetiologic distribution of acute pericarditis vary significantly from study to study. We attempted to summarise reports on incidence of different aetiologies of pericarditis and explain the variable range of reported frequencies of different aetiologies. The literature between 1978 and 2005 was reviewed for comparative incidence of acute pericarditis. Reports of more than 50 subjects were included. The most common cause of pericarditis was 'idiopathic' pericarditis (mean: 26.1%), followed by neoplastic diseases (mean: 25.6%) and iatrogenic pericarditis (mean: 16.3%). Each mean had a wide range of 95% confidence interval. In summary, the clinician is confronted by a huge dispersion of reported frequencies of pericarditis aetiologies as a consequence of multiple factors. Recognising specific rare causes of pericarditis, often essential for early diagnosis and successful treatment, means coping with that aetiologic dispersion and its implied probabilities.

Controversial Issues in the Management of Pericardial Diseases

“…At least 2 of 4 should be present for the diagnosis of acute pericarditis. [3][4][5][6][7][8][9][10][11][12] The inclusion of pericardial effusion, not universally accepted, 1,5 is justified considering that this feature, although not necessary, is a confirmatory finding when present. At the same time, evidence of elevated inflammatory markers (e.g.…”

“…Although the clinical diagnosis of pericarditis is relatively simple (Tables 1 and 2), [1][2][3][4][5][6][7][8][9][10][11][12][13] establishing the cause may be more difficult. A major controversy in "pericardiology" is the role of an extensive etiologic search and hospital admission for all patients with pericarditis or pericardial effusion.…”

“…A major controversy in "pericardiology" is the role of an extensive etiologic search and hospital admission for all patients with pericarditis or pericardial effusion. [1][2][3][4][5][6][7][8] The causes of pericarditis are varied (Table 3), 9 and the clinician should identify causes that require targeted therapies. The epidemiological background is essential to develop a rational cost-effective management program 3,4,15,16 ; the approach may be different for research, when we attempt to reduce the number of "idiopathic" cases.…”

‘Lone’ atrial fibrillation: Hunting for the underlying causes and links

“…As mentioned before, lone AF does not necessarily mean 'idiopathic'. As Lorbar and Spodick pointed out in the case of pericarditis: 'nothing is idiopathic'; suggesting that meticulous investigation and consideration of contemporary pathogenetic mechanisms may reveal or clarify, at least in part, the underlying etiology [9]. Nevertheless, this point of view could also be applied in the case of lone AF.…”

The Relation of Inflammatory Markers to Idiopathic Pericardial Effusion

“…A large proportion of these cases are defined as idiopathic pericarditis (26.1%). The other following causes for PE are neoplastic diseases (25.6%) and iatrogenic disorders (16.3%) (4) .…”