A Study on Aetiology and Clinical Profile of Significant Pericardial Effusion at a Tertiary Care Hospital in Eastern India

Background: This study was done to determine the aetiology in 25 patients who underwent pericardiocentesis due to cardiac tamponade, large pericardial effusion or for diagnostic purpose through analysis of their echocardiographic findings, biochemical and cytological test results, and imaging methods in a tertiary care centre in sub-Himalayan West Bengal. Material and Methods: 25 consecutive patients selected by purposive sampling underwent USG guided pericardiocentesis and their echocardiograms, biochemical test results, imaging results, pericardial fluid, culture, and cytology results. All data of the patients were recorded and analyzed. Results: The most common indication was for diagnostic dilemma in 56% patients whereas 28% had tamponade. Tubercular pericardial effusion was the commonest aetiology in 32% patients and this was also the commonest cause among those done for diagnostic purpose while tamponade indications appeared across CKD, neoplastic, autoimmune, and idiopathic categories. Serosanguinous/haemorrhagic fluid was sensitive but less specific for tuberculosis because haemorrhagic fluid also occurred in non-tubercular aetiologies. Malignant cells were positive in 75% of the neoplastic effusions. Conclusion: This study was the first one to be carried out in this geographical region and the high prevalence of tuberculosis may contribute to the aetiology of extrapulmonary TB in this setting. Dyspnoea was present in majority of cases and Chest X ray should be done in these cases to exclude cardiomegaly with suspicion of pericardial effusion as a cause. There are no specific echocardiographic features indicating cause but macroscopic nature including fibrin strands, cytology and ADA has high diagnostic performance.

Keywords: Pericardial effusion, pericardiocentesis, Extrapulmonary Tuberculosis, ADA, tamponade.