Utilidade da pericardioscopia no diagnóstico de derrame pericárdico / Usefulness of pericardioscopy in the diagnosis of pericardial effusion

O pericárdio pode ser afetado por doenças infecciosas, neoplásicas, inflamatórias e metabólicas. Muitas condições exigem tratamentos específicos, de forma que um diagnóstico preciso é importante. Assim, a biópsia do pericárdio tem um papel importante na avaliação dos derrames pericárdicos. A pericardioscopia oferece a vantagem da tradicional abordagem subxifóide ao permitir acesso a partes do pericárdio que não poderiam ser alcançadas através de palpação digital, bem como visibilização direta através da janela subxifóide ou toracoscopia. Reportamos o caso de um paciente com grande derrame pericárdico e massa mediastinal não-diagnosticada, em quem a pericardioscopia videoassistida foi fundamental no diagnóstico e tratamento da doença.

The pericardium can be affected by infectious, neoplastic, inflammatory and metabolic diseases. Many conditions require specific treatment and, consequently, an accurate diagnosis is important. Therefore, the pericardial biopsy has an important role in the evaluation of pericardial effusions. The pericardioscopy offers the advantage of the traditional subxiphoid approach, as it allows access to parts of the pericardium that would not be reached by digital palpation, as well as direct visualization through the subxiphoid window or thoracoscopy. We report the case of a patient with a large pericardial effusion and an undiagnosed mediastinal mass, in which video-assisted pericardioscopy was fundamental in the diagnosis and treatment of the disease.

The Usefulness of Pericardial Biopsy to Evaluate the Causes of Pericardial Disease

BACKGROUND AND OBJECTIVES: The identification of a specific etiology of effusive pericardial disease is difficult because of the limited yield of cytologic and microbiologic pericardial fluid analysis. We performed retrospective study to find out whether pericardial biopsy was superior to pericardial fluid analysis in search of the etiology of pericardial effusion. MATERIALS AND METHOD: We reviewed 76 cases of moderate to severe pericardial effusion on which we performed surgical pericardial biopsy from Sep. 1986 to Sep. 1996. The results of pericardial fluid analysis, clinical manifestation, pericardial biopsy were compared retrospectively. RESULTS: 1)Clinical diagnosis of pericardial effusion were as follow:neoplastic disease (7.9%), tuberculosis (72.4%), constrictive pericarditis (17.1%), and others (2.6%). 2)By the percutaneous pericardial biopsy, we confirmed 19 cases (25%). Etiology of 4 cases (5.3%) were malignancy and 15 cases (19.7%) tuberculosis. Fifteen out of 76 patients who were diagnosed by biopsy as tuberculous pericarditis and 28 patients who were suspected as tuberculous pericarditis clinically were treated with antituberculous medications. Ten patients (66.7%) of pathologically diagnosed patients and 18 patients (69.2%) of clinically diagnosed patients showed complete resolution of pericarditis. CONCLUSION: By pericardial biopsy, we only confirmed 19 cases (25.0%). It means that pericardial biopsy is not superior to pericardial fluid analysis in searching of etiology of pericardial effusion. Moreover, it is not sufficient for final diagnosis of pericardial effusion.