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Evaluation of pericardial effusions in a community hospital : a thesis submitted to the faculty of the Milwaukee School of Engineering in partial fulfillment of the requirements for the degree of Master of Science in Cardiovascular Studies / by Daniel J. Cvikota.

by Cvikota, Daniel J., author., Milwaukee School of Engineering

Pericardial effusions -- Diagnosis

Pericardium -- Diseases -- Diagnosis

52 leaves : illustrations ; 29 cm.

Introduction -- Background -- Study objectives -- Methods -- Results -- Discussion -- Further consideration -- Conclusion.

There is little published research on the systematic analysis of pericardial effusions, in part because of the scarcity of these specimens in a laboratory setting. When they are analyzed, fluid chemistries, microbiology cultures, and cytologic evaluation are common, and are aimed at contributing to the determination of the etiology of the effusion. There are, however, limitations to the diagnostic utility of each of these tools. For example, even the normal ranges for determination of fluid chemistries is still up for debate. A better understanding of the predictive nature of clinical laboratory tests and cytopathology of pericardial fluid would aid both diagnosis and treatment. The objective of this study was to retrospectively analyze a large cohort of pericardial fluid specimens collected at a single facility in order to determine the relative incidences of the etiologies, and the benefit of clinical laboratory tests and cytopathology evaluation in determining those etiologies.

After IRB approval, both the Powerchart database and Cerner CoPath anatomic pathology database were searched for all patients with a pericardial effusion evaluated at Memorial Medical Center in Springfield, Illinois over a five-year period spanning January 1, 2009 to December 31, 2013. Clinical history, clinical laboratory data, cytopathology reports and surgical pathology reports were retrospectively reviewed. The data were used to determine if the test results supported the diagnosis and if incidence rates were comparable to those previously published.

In this study, a total of 74 pericardial effusions were obtained, representing 2.7% of all 2,760 fluid specimens (pleural=1,909; ascites=777) processed by the cytopathology laboratory during the five-year timeframe. A combination of laboratory tests were used to help determine their etiology. Chemistries such as LDH and total protein were not routinely run on the pericardial fluid specimens in this study as they are generally not helpful in determining the etiology of these effusions, as many of the parameters overlap. Microbiologic cultures and cytologic evaluation were proven to be valuable tools as both show a high sensitivity for detecting infection and malignancy, respectively. Although cytology is superior to pericardial biopsy in detecting malignancy, the combination of cytopathology and surgical pathology often allowed for a more definitive diagnosis. Knowledge of the usefulness and limitations of the laboratory tests employed in the fluid analysis will allow the clinician to best determine the specific etiology of the effusion and tailor treatment. The rates and causes of malignant specimens in this study were similar to those previously published by others.

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