Echocardiographic and Clinical Findings of Massive Pericardial Effusion in Medical Patients

Abstract

Fifty-one patients with massive pericardial effusion were found in a five -year period among the 10,500 patients referred for echocardiography. Malignant pericardial effusion, found in 21 of the 51 patients was the most common etiology. Tachypnea, tacycardia, elevated jugular venous pressure and arterial hypotension were commonly found. Cardiac tamponade occurred in 29 patients with malignant pericardial effusion accounting for tamponade in 16 of the 29 patients. Two-dimensional echocardigraphy showed right atrial collapse in 19 of the 29 patients with tamponade, and in 3 of the remaining 33 patients without; right ventricular collapse in 23 patients with tamponade and in 4 patients without tamponade. The sensitivity and specificity of right atrial collapse in the diagnosis of tamponade was 66﹪ and 86﹪, respectively. The sensitivity and specificity of right ventricular collapse in the diagnosis of tamponade was 79﹪ and 82﹪, respectively. Sixteen of the 51 patients died during a follow-up period of one day to one year. Percutaneous pericardiocentesis or surgical drainage was performed in 31 patients. In conclusion, massive pericardial effusion was uncommon in routine echocardiographic examination and malignancy was the most common etiology. The prognosis of massive pericardial effusion depended on patients' underlying disease. Two - dimensional echocardiography was a good noninvasive diagnostic tool to detect the presence of pericardial effusion and cardiac tamponade. 於5年期 間，在10,500位病人接受超音波心圖檢查時，發現有51位病人患有大量心包膜積水。 其中惡性心包膜積水有21位，佔最多數。呼吸急促，心博過速，頸靜脈怒張及低血壓 為臨床上常見的特徵，發生心包膜填塞的病人有29位，其中16位為惡性積水。在29位 心包膜填塞病人中，19位在雙面超音波心圖顯示有右心房塌陷；其餘22位沒有心包膜 填塞的病人，則只有3位有此現象。在心包膜填塞病人中有23位發生右心室塌陷，沒 有心包膜填塞的病人則有4 位有此現象。右心房塌陷診斷心包膜填塞的敏感度及特異 性分別為66﹪及86﹪；右心室塌陷的敏感度及特異性則分別為79﹪及82﹪。在追蹤1 年當中，有16位病人死亡。31位病人在住院期間，接受經皮心包膜穿刺或外科引流手 術。總之，大量心包膜積水在常規超音波心圖檢查中並不常見，惡性積水為造成大量 心包膜積水最常見的原因。大量心包膜積水的預後依其本身所患疾病而定，患有惡性 積水者，其預後較差。