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Kostelecky N, Kreutz K, Lin CY. Sensitivity of Antemortem Imaging for Pericarditis: An Institutional Experience. Am J Forensic Med Pathol 2023; 44:21-24. [PMID: 36580385 DOI: 10.1097/paf.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Pericarditis is a challenging diagnosis with nonspecific manifestations, significant clinical implications, and possible mortality. The advancement of imaging, such as echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI), has improved the sensitivity of diagnosis, although limitations remain. In this study, we investigated the prevalence of pericarditis identified at autopsy and correlated these findings with antemortem imaging studies and clinical information. Thirty-four decedents were identified in our archival autopsy records (prevalence, 1.23%) from 2010 to 2021 with a postmortem diagnosis of pericarditis. Thirty-five antemortem imaging studies were performed on 32 decedents, of which CT was the most common (18/35, 51.4%). The sensitivity of antemortem imaging was poor, with CT showing the highest sensitivity at 16.7% (3/18), while echocardiography studies, transthoracic (TTE) and transesophageal (TEE), each had a sensitivity of 0.0%. Pericarditis was determined as the immediate cause of death by autopsy in 13 decedents, of which 3 were diagnosed antemortem. It was considered contributory to the death in 6 decedents, none of which were diagnosed antemortem. In summary, antemortem imaging has limited utility in the diagnosis of pericarditis. It is imperative to examine the pericardium during autopsy to identify a possible cause of death or contributing factor.
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Affiliation(s)
- Nicolas Kostelecky
- From the Department of Pathology, Northwestern Memorial Hospital Feinberg School of Medicine, Chicago, IL
| | - Kasey Kreutz
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
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Gouriet F, Levy PY. Management of Pericardial Effusion. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gouriet F, Levy PY, Casalta JP, Zandotti C, Collart F, Lepidi H, Cautela J, Bonnet JL, Thuny F, Habib G, Raoult D. Etiology of Pericarditis in a Prospective Cohort of 1162 Cases. Am J Med 2015; 128:784.e1-8. [PMID: 25770033 DOI: 10.1016/j.amjmed.2015.01.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pericarditis is a common disorder that is present in various pathologies and may be the first manifestation of an underlying systemic disease. The aims of this study were to describe the different causes of infectious and noninfectious pericarditis and compare them with those in the literature. METHODS Between May 2007 and September 2012, we prospectively evaluated a strategy using a systematic prescription of tests for the different etiological causes of pericarditis in patients with acute pericarditis who were hospitalized in the Cardiology and Cardiac Surgery Department or admitted to the Emergency Department (University Hospital of Marseille). A total of 1162 patients with suspected pericarditis were included. A standardized diagnosis procedure was performed for 800 patients, and 362 had pericardiocentesis. RESULTS Acute pericarditis was diagnosed in 933 patients. No diagnosis was established in 516 patients (55%), 197 patients suffered from postinjury syndromes, and 156 had previously known diseases that were associated with pericarditis. Our survey allowed us to relate the probable cause of pericarditis in 64 cases. An infectious etiological diagnosis was established in 53 cases. In our study, postinjury syndrome was the leading cause of pericarditis, a new diagnosis was made in 6.7% of cases, and 16% of the diagnoses were linked to a secondary, underlying disease. CONCLUSION Using this strategy, we were able to reduce the number of idiopathic cases. In many cases, the etiologies were still identified. Long-term follow-up in the management of idiopathic pericarditis should remain of great interest for the future diagnosis of other disorders that remain hidden.
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Affiliation(s)
- Frédérique Gouriet
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Pierre-Yves Levy
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Jean-Paul Casalta
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Christine Zandotti
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Frédéric Collart
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Hubert Lepidi
- Département d'anathomopathologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Jennifer Cautela
- Département de Cardiologie, Hôpital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Jean Louis Bonnet
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Franck Thuny
- Département de Cardiologie, Hôpital Nord, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UMR CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
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Analysis of pericardial effusion from idiopathic pericarditis patients by two-dimensional gel electrophoresis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:942718. [PMID: 24804262 PMCID: PMC3996951 DOI: 10.1155/2014/942718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/26/2014] [Indexed: 11/17/2022]
Abstract
Pericardial fluid (PF) is often considered to be reflection of the serum by which information regarding the physiological status of the heart can be obtained. Some local and systemic disorders may perturb the balance between synthesis and discharge of PF and may cause its aberrant accumulation in the pericardial cavity as pericardial effusion (PE). PE may then lead to an increased intrapericardial pressure from which the heart function is undesirably affected. For some cases, the causes for the perturbance of fluid balance are well understood, but in some other cases, they are not apparent. It may, thus, be helpful to understand the molecular mechanisms behind this troublesome condition to elucidate a clinical approach for therapeutic uses. In this study, protein profiles of PEs from idiopathic pericarditis patients were analyzed. Control samples from patients undergoing elective cardiac surgery (ECS) were included for comparison. In addition to high abundant serum-originated proteins that may not hold significance for understanding the molecular mechanisms behind this disease, omentin-1 was identified and its level was higher for more than two-fold in PE of IP patients. Increased levels of omentin-1 in PE may open a way for understanding the molecular mechanisms behind idiopathic pericarditis (IP).
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Abstract
The risk of developing pericarditis is similar in men and women. However, systemic autoimmune diseases are more common in women and may determine an increased risk of recurrences and complications. Specific management issues for women with pericarditis include pregnancy and lactation. Relatively few data have been published on pericardial involvement during pregnancy, and major concerns of clinicians are related to management issues, especially medical treatment. Nowadays, the general outcomes of these pregnancies can be similar to that expected in the general population when carefully followed by dedicated multidisciplinary teams. The aim of this article is to review the management of pericarditis with a focus on gender-specific issues.
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Liu YC, Gau JP, Hong YC, Yu YB, Hsiao LT, Liu JH, Chiou TJ, Chen PM, Tzeng CH. Large pericardial effusion as a life-threatening complication after hematopoietic stem cell transplantation—association with chronic GVHD in late-onset adult patients. Ann Hematol 2012; 91:1953-8. [DOI: 10.1007/s00277-012-1541-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
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Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev 2012; 18:355-60. [DOI: 10.1007/s10741-012-9328-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Imazio M, Brucato A, Mayosi BM, Derosa FG, Lestuzzi C, Macor A, Trinchero R, Spodick DH, Adler Y. Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown) 2010; 11:712-22. [PMID: 20736783 DOI: 10.2459/jcm.0b013e3283340b97] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive pericarditis. Medical treatment should be targeted at the cause of the disease as much as possible. However, the cause of pericardial diseases may be varied and depends on the prevalence of specific diseases (especially tuberculosis). The search for an etiology is often inconclusive, and most cases are classified as idiopathic in developed countries where tuberculosis is relatively rare, whereas a tuberculous etiology is often presumed in developing countries where tuberculosis is endemic. The aim of the present article is to review current medical therapy for pericardial diseases, highlighting recent significant advances in clinical research, ongoing challenges and unmet needs. Following a probabilistic approach, the most common causes are considered (idiopathic, viral, tuberculous, purulent, connective tissue diseases and neoplastic pericardial disease). In this article, the therapy of idiopathic and more common forms of infectious pericarditis (viral and bacterial) is reviewed.
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Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy.
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Lestuzzi C, Bearz A, Lafaras C, Gralec R, Cervesato E, Tomkowski W, DeBiasio M, Viel E, Bishiniotis T, Platogiannis DN, Buonadonna A, Tartuferi L, Piazza R, Tumolo S, Berretta M, Santini F, Imazio M. Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study. Lung Cancer 2010; 72:340-7. [PMID: 21122938 DOI: 10.1016/j.lungcan.2010.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/23/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis. METHODS We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease. RESULTS A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p<0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p<0.001). Survival was significantly better after combined chemotherapy (p<0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ(2)=7.69, p<0.01). CONCLUSIONS Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.
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Affiliation(s)
- Chiara Lestuzzi
- Division of Cardiology, CRO, Centro di Riferimento Oncologico (National Cancer Institute), Aviano, Pordenone, Italy.
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Imazio M, Spodick DH, Brucato A, Trinchero R, Markel G, Adler Y. Diagnostic issues in the clinical management of pericarditis. Int J Clin Pract 2010; 64:1384-92. [PMID: 20487049 DOI: 10.1111/j.1742-1241.2009.02178.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIMS To review the current major diagnostic issues on the diagnosis of acute and recurrent pericarditis. METHODS To review the current available evidence, we performed a through search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive Medline search with the MeSH terms 'pericarditis', 'etiology' and 'diagnosis'. RESULTS The diagnosis of pericarditis is based on clinical criteria including symptoms, presence of specific physical findings (rubs), electrocardiographical changes and pericardial effusion. Although the aetiology may be varied, most cases are idiopathic or viral, even after an extensive diagnostic evaluation. In such cases, the course is often benign following anti-inflammatory treatment, and management would be not affected by a more precise diagnostic evaluation. A triage of pericarditis can be safely performed on the basis of the clinical and echocardiographical presentation. Specific diagnostic tests are not warranted if no specific aetiologies are suspected on the basis of the epidemiological background, history and presentation. High-risk features associated with specific aetiologies or complications include: fever > 38 degrees C, subacute onset, large pericardial effusion, cardiac tamponade, lack of response to aspirin or a NSAID. CONCLUSIONS A targeted diagnostic evaluation is warranted in acute and recurrent pericarditis, with a specific aetiological search to rule out tuberculous, purulent or neoplastic pericarditis, as well as pericarditis related to a systemic disease, in selected patients according to the epidemiological background, presentation and clinical suspicion.
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Affiliation(s)
- M Imazio
- Cardiology Department, Maria Vittoria Hospital, Torino, Italy.
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Calabrese F, Carturan E, Thiene G. Cardiac infections: focus on molecular diagnosis. Cardiovasc Pathol 2010; 19:171-82. [DOI: 10.1016/j.carpath.2009.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 01/09/2023] Open
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Imazio M, Spodick DH, Brucato A, Trinchero R, Adler Y. Controversial Issues in the Management of Pericardial Diseases. Circulation 2010; 121:916-28. [DOI: 10.1161/circulationaha.108.844753] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Massimo Imazio
- From the Cardiology Department, Maria Vittoria Hospital, Torino, Italy (M.I., R.T.); Department of Medicine, St Vincent Hospital, University of Massachusetts, Worcester (D.H.S.); Internal Medicine, Ospedali Riuniti, Bergamo, Italy (A.B.); and Gertner Institute for Epidemiology and Health Policy Research, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Misgav Ladach Hospital, Jerusalem, Kupat Holim
| | - David H. Spodick
- From the Cardiology Department, Maria Vittoria Hospital, Torino, Italy (M.I., R.T.); Department of Medicine, St Vincent Hospital, University of Massachusetts, Worcester (D.H.S.); Internal Medicine, Ospedali Riuniti, Bergamo, Italy (A.B.); and Gertner Institute for Epidemiology and Health Policy Research, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Misgav Ladach Hospital, Jerusalem, Kupat Holim
| | - Antonio Brucato
- From the Cardiology Department, Maria Vittoria Hospital, Torino, Italy (M.I., R.T.); Department of Medicine, St Vincent Hospital, University of Massachusetts, Worcester (D.H.S.); Internal Medicine, Ospedali Riuniti, Bergamo, Italy (A.B.); and Gertner Institute for Epidemiology and Health Policy Research, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Misgav Ladach Hospital, Jerusalem, Kupat Holim
| | - Rita Trinchero
- From the Cardiology Department, Maria Vittoria Hospital, Torino, Italy (M.I., R.T.); Department of Medicine, St Vincent Hospital, University of Massachusetts, Worcester (D.H.S.); Internal Medicine, Ospedali Riuniti, Bergamo, Italy (A.B.); and Gertner Institute for Epidemiology and Health Policy Research, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Misgav Ladach Hospital, Jerusalem, Kupat Holim
| | - Yehuda Adler
- From the Cardiology Department, Maria Vittoria Hospital, Torino, Italy (M.I., R.T.); Department of Medicine, St Vincent Hospital, University of Massachusetts, Worcester (D.H.S.); Internal Medicine, Ospedali Riuniti, Bergamo, Italy (A.B.); and Gertner Institute for Epidemiology and Health Policy Research, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Misgav Ladach Hospital, Jerusalem, Kupat Holim
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‘Lone’ atrial fibrillation: Hunting for the underlying causes and links. Int J Cardiol 2009; 131:180-5. [PMID: 18687489 DOI: 10.1016/j.ijcard.2008.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/27/2008] [Accepted: 06/28/2008] [Indexed: 11/19/2022]
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Sari I, Davutoglu V, Ozer O, Sucu M. Tuberculosis as aetiology of so-called idiopathic pericarditis. Int J Clin Pract 2007; 61:1766. [PMID: 17877663 DOI: 10.1111/j.1742-1241.2007.01541.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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