The role of early contrast-enhanced chest computed tomography in the aetiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion

Maggiolini, Stefano; Carlini, C De; Ferri, Luca; Colombo, Gualtiero I.; Gentile, Gaetano; Meles, Ester; Riva, Beatrice; Casella, Teresa C.; Imazio, Massimo; Brucato, Antonio

doi:10.1093/ehjci/jev225

Cited by 27 publications

(19 citation statements)

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“…The term ‘idiopathic’ was applied to cases that performed a complete diagnostic evaluation to exclude a specific aetiology, including tuberculosis, cancer, postoperative and systemic inflammatory diseases, with non-invasive diagnostic tests (eg, CT scan)7 and analysis of pericardial fluid whenever indicated according to guidelines 2. The term ‘chronic’ was adopted for a pericardial effusion lasting >3 months 2–4.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of idiopathic chronic large pericardial effusion

Imazio

Lazaros

Valenti

et al. 2018

Heart

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ObjectiveAim of this paper is to evaluate the outcomes of ‘idiopathic’ chronic large pericardial effusions without initial evidence of pericarditis.MethodsAll consecutive cases of idiopathic chronic large pericardial effusions evaluated from 2000 to 2015 in three Italian tertiary referral centres for pericardial diseases were enrolled in a prospective cohort study. The term ‘idiopathic’ was applied to cases that performed a complete diagnostic evaluation to exclude a specific aetiology. A clinical and echocardiographic follow-up was performed every 3–6 months.Results100 patients were included (mean age 61.3±14.6 years, 54 females, 44 patients were asymptomatic according to clinical evaluation) with a mean follow-up of 50 months. The baseline median size of the effusion (evaluated as the largest end-diastolic echo-free space) was 25 mm (IQR 8) and decreased to a mean value of 7 mm (IQR 19; p<0.0001) with complete regression in 39 patients at the end of follow-up. There were no new aetiological diagnoses. Adverse events were respectively: cardiac tamponade in 8 patients (8.0%), pericardiocentesis in 30 patients (30.0%), pericardial window in 12 cases (12.0%) and pericardiectomy in 3 patients (3.0%). Recurrence-free survival and complications-free survival was better in patients treated without interventions (log rank p=0.0038).ConclusionsThe evolution of ‘idiopathic’ chronic large pericardial effusions is usually benign with reduction of the size of the effusion in the majority of cases, and regression in about 40% of cases. The risk of cardiac tamponade is 2.2%/year and recurrence/complications survival was better in patients treated conservatively without interventions.

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Section: Methodsmentioning

confidence: 99%

Outcomes of idiopathic chronic large pericardial effusion

Imazio

Lazaros

Valenti

et al. 2018

Heart

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“…Pericardial involvement is a common occurrence in cancer, often associated with a poor prognosis 1 2. The prevalence of heart and pericardium involvement in malignancies varies between 5% and 20% in autopsy series and clinical studies,3–5 and it significantly affects survival 2 6–8…”

Section: Introductionmentioning

confidence: 99%

“…Primary tumours of the pericardium are rare. Secondary or metastatic pericardial invasion is, in contrast, much more common, arising in most cases from lung and breast carcinoma, haematological malignancies, and gastrointestinal cancer 2 9–12…”

Section: Introductionmentioning

confidence: 99%

“…The spectrum of malignant pericardial diseases may range from minimal pericardial effusion to cardiac tamponade, and pericardial effusion can be the initial clue of an occult malignancy 1 4 7 8. Cancer is the predominant aetiology of large symptomatic pericardial effusion, being responsible for about one-third of cases presenting with haemodynamic instability due to cardiac tamponade 2 6 8…”

Section: Introductionmentioning

confidence: 99%

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Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes

Imazio

Colopi

Ferrari

2020

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Neoplastic pericardial effusion is a common and serious manifestation of advanced malignancies. Lung and breast carcinoma, haematological malignancies, and gastrointestinal cancer are the most common types of cancer involving the pericardium. Pericardial involvement in neoplasia may arise from several different pathophysiological mechanisms and may be manifested by pericardial effusion with or without tamponade, effusive-constrictive pericarditis and constrictive pericarditis. Management of these patients is a complex multidisciplinary problem, affected by clinical status and prognosis of patients.

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“…CT generally provides anatomic information and defines the extent of pericardial calcification, but with administration of iodinated contrast medium it is possible to detect pericardial inflammation because of the enhancement of the inflamed pericardium after contrast injection. [9] CT, if extended to thorax and abdomen, may detect neoplastic masses or lymphadenopathies, thus suggesting possible tuberculosis.…”

Section: Clinical Managementmentioning

confidence: 99%

Clinical management and therapy of idiopathic recurrent pericarditis

Assolari

Maestroni

Cumetti

et al. 2019

CMI

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Recurrent pericarditis is defined when pericarditic chest pain reappears after a symptom-free period of at least 4 to 6 weeks and after completion of full-dose anti-inflammatory therapy. Idiopathic pericarditis is the commonest etiology. The diagnosis of idiopathic cases is essentially an exclusion diagnosis, supported by a typical clinical course. The diagnosis is based on the association of typical symptoms and signs: mainly pericarditic chest pain plus pericardial rubs or electrocardiographic alterations or pericardial effusion. The optimal regimen for recurrences includes combination of non-steroidal anti-inflammatory agents, colchicine, and corticosteroids. In the resistant forms, immunotherapy (azathioprine, intravenous immunoglobulins, and particularly anakinra) has shown to be effective. The long term outcome of idiopathic recurrent pericarditis is good, with no evolution towards constrictive form.

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The role of early contrast-enhanced chest computed tomography in the aetiological diagnosis of patients presenting with cardiac tamponade or large pericardial effusion

Cited by 27 publications

References 28 publications

Outcomes of idiopathic chronic large pericardial effusion

Outcomes of idiopathic chronic large pericardial effusion

Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes

Clinical management and therapy of idiopathic recurrent pericarditis

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