Pericarditis other diagnostic studies: Difference between revisions
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**[Finding 2] | **[Finding 2] | ||
**[Finding 3] | **[Finding 3] | ||
==Diagnostic Pericardiocentesis== | |||
[[Pericardiocentesis]] is a relatively safe [[procedure]] when guided by [[echocardiography]], especially when large free [[anterior]] [[pericardial effusion]] is present. [[Pericardial fluid]] should be [[Aspiration|aspirated]] and [[Test|tested]] for the presence of [[malignant]] [[Cells (biology)|cells]] and [[tumor marker]]s, particularly in [[patients]] with [[hemorrhagic]] [[Pericardial Effusion|effusion]] without preceding [[trauma]]. However, [[hemorrhagic]] [[pericarditis]] in developing countries could be due to [[tuberculosis]]. [[Sensitivity (tests)|Sensitivity]] of [[cytology|cytological]] [[analysis]] of [[pericardial fluid]] for [[malignant]] [[Cells (biology)|cells]] was 67%, 75%, and 92% in different studies with specificity of 100%. [[Immunohistochemistry]] can be used to distinguish between the [[malignant]] [[Cells (biology)|cells]] and their possible [[origin]].<ref name="pmid12508174">{{cite journal| author=Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW| title=Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block. | journal=Diagn Cytopathol | year= 2003 | volume= 28 | issue= 1 | pages= 1-5 | pmid=12508174 | doi=10.1002/dc.10219 | pmc= | url= }} </ref><ref name="pmid9068950">{{cite journal| author=Mayall F, Heryet A, Manga D, Kriegeskotten A| title=p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology. | journal=Cytopathology | year= 1997 | volume= 8 | issue= 1 | pages= 9-12 | pmid=9068950 | doi= | pmc= | url= }} </ref><ref name="pmid10593777">{{cite journal| author=Atar S, Chiu J, Forrester JS, Siegel RJ| title=Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? | journal=Chest | year= 1999 | volume= 116 | issue= 6 | pages= 1564-9 | pmid=10593777 | doi= | pmc= | url= }} </ref><ref name="pmid2028688">{{cite journal| author=Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U| title=The diagnostic value of pericardial cytology. An analysis of 95 cases. | journal=Acta Cytol | year= 1991 | volume= 35 | issue= 2 | pages= 149-53 | pmid=2028688 | doi= | pmc= | url= }} </ref><ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref><ref name="pmid9149572">{{cite journal| author=Meyers DG, Meyers RE, Prendergast TW| title=The usefulness of diagnostic tests on pericardial fluid. | journal=Chest | year= 1997 | volume= 111 | issue= 5 | pages= 1213-21 | pmid=9149572 | doi= | pmc= | url= }} </ref> | |||
[[Aspirate|Aspirated]] [[fluid]] can also be used for the following tests: | |||
*[[Gram staining]] | |||
*[[Acid-fast]] staining | |||
*[[Microbial culture]] | |||
==Pericardial Biopsy== | |||
If the [[clinical]] suspicion of [[malignancy]] is high, and if the results of [[cytology]] [[testing]] from the [[pericardiocentesis]] are negative, consideration should be given to performing a [[pericardial]] [[biopsy]]. This can be performed via either a [[subxiphoid]] or transthoracic pericardiostomy or alternatively by pericardioscopy. The advantages of pericardioscopy include helping to directly visualize the [[pericardium]] as well as helping to collect the [[biopsy]] sample. Pericardioscopy has an excellent [[Sensitivity (tests)|sensitivity]] of 97%, which compares quite favorably to a [[blind]] [[biopsy]] which has a low [[Sensitivity (tests)|sensitivity]] of 55-65%.<ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref><ref name="pmid8840855">{{cite journal| author=Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A et al.| title=Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. | journal=Circulation | year= 1996 | volume= 94 | issue= 7 | pages= 1635-41 | pmid=8840855 | doi= | pmc= | url= }} </ref> | |||
==References== | ==References== | ||
Revision as of 20:06, 18 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]
Overview
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include:
- [Finding 1]
- [Finding 2]
- [Finding 3]
OR
Other diagnostic studies for [disease name] include:
- [Diagnostic study 1], which demonstrates:
- [Finding 1]
- [Finding 2]
- [Finding 3]
- [Diagnostic study 2], which demonstrates:
- [Finding 1]
- [Finding 2]
- [Finding 3]
Diagnostic Pericardiocentesis
Pericardiocentesis is a relatively safe procedure when guided by echocardiography, especially when large free anterior pericardial effusion is present. Pericardial fluid should be aspirated and tested for the presence of malignant cells and tumor markers, particularly in patients with hemorrhagic effusion without preceding trauma. However, hemorrhagic pericarditis in developing countries could be due to tuberculosis. Sensitivity of cytological analysis of pericardial fluid for malignant cells was 67%, 75%, and 92% in different studies with specificity of 100%. Immunohistochemistry can be used to distinguish between the malignant cells and their possible origin.[1][2][3][4][5][6]
Aspirated fluid can also be used for the following tests:
- Gram staining
- Acid-fast staining
- Microbial culture
Pericardial Biopsy
If the clinical suspicion of malignancy is high, and if the results of cytology testing from the pericardiocentesis are negative, consideration should be given to performing a pericardial biopsy. This can be performed via either a subxiphoid or transthoracic pericardiostomy or alternatively by pericardioscopy. The advantages of pericardioscopy include helping to directly visualize the pericardium as well as helping to collect the biopsy sample. Pericardioscopy has an excellent sensitivity of 97%, which compares quite favorably to a blind biopsy which has a low sensitivity of 55-65%.[5][7]
References
- ↑ Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW (2003). "Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block". Diagn Cytopathol. 28 (1): 1–5. doi:10.1002/dc.10219. PMID 12508174.
- ↑ Mayall F, Heryet A, Manga D, Kriegeskotten A (1997). "p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology". Cytopathology. 8 (1): 9–12. PMID 9068950.
- ↑ Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
- ↑ Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U (1991). "The diagnostic value of pericardial cytology. An analysis of 95 cases". Acta Cytol. 35 (2): 149–53. PMID 2028688.
- ↑ 5.0 5.1 Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
- ↑ Meyers DG, Meyers RE, Prendergast TW (1997). "The usefulness of diagnostic tests on pericardial fluid". Chest. 111 (5): 1213–21. PMID 9149572.
- ↑ Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A; et al. (1996). "Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients". Circulation. 94 (7): 1635–41. PMID 8840855.