From the Guidelines
The diagnostic workup for pericardial effusion due to infection involves a comprehensive approach, including echocardiography and pericardiocentesis, as well as laboratory analysis of pericardial fluid, to identify the underlying cause of the effusion 1.
Initial Evaluation
The initial evaluation should include:
- Chest radiograph to identify changes suggestive of pulmonary tuberculosis or other infections
- Echocardiogram to assess the size and characteristics of the pericardial effusion
- CT scan and/or MRI of the chest to evaluate for pericardial thickening and mediastinal lymphadenopathy
- Culture of sputum, gastric aspirate, and/or urine for Mycobacterium tuberculosis (M. tuberculosis) or other pathogens
Pericardiocentesis
Pericardiocentesis is indicated for:
- Therapeutic purposes in cases of cardiac tamponade
- Diagnostic purposes to analyze pericardial fluid for:
- Direct culture for M. tuberculosis or other pathogens
- Quantitative polymerase chain reaction (Xpert MTB/RIF) testing for nucleic acids of M. tuberculosis
- Biochemical tests to distinguish between exudative and transudative effusions
- White cell analysis and count, and cytology to identify lymphocytic or other types of exudates
Pericardial Biopsy
Pericardial biopsy may be considered in selected cases, particularly when:
- Tuberculous pericarditis is suspected and empiric antituberculosis treatment is being considered
- Neoplastic pericarditis is suspected and a diagnostic biopsy is necessary to establish the diagnosis
Empiric Antituberculosis Chemotherapy
Empiric antituberculosis chemotherapy may be initiated in patients with suspected tuberculous pericarditis, particularly in areas where tuberculosis is endemic, after excluding other causes of pericardial effusion 1. The choice of empiric antibiotic therapy should be guided by the suspected underlying cause of the pericardial effusion, as well as local antimicrobial resistance patterns, and may include rifampicin, isoniazid, pyrazinamide, and ethambutol for tuberculous pericarditis 1.
From the Research
Diagnostic Workup for Pericardial Effusion due to Infection
The diagnostic workup for pericardial effusion due to infection involves various imaging techniques, including:
- Echocardiography, which is the first imaging choice when pericardial effusions are suspected 2
- Cross-sectional computed tomography (CT) and cardiac magnetic resonance (MR) imaging, which also have important roles in diagnosing pericardial effusions 2
- Chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis, which are utilized to evaluate pericardial effusion 3
- Reverse transcription-polymerase chain reaction (RT-PCR) and serology tests, which may be necessary to diagnose the underlying infection, such as COVID-19 4
Key Considerations
- Pericardial effusion can be caused by various infections, including COVID-19 4, and the diagnostic workup should consider the patient's clinical presentation and medical history
- The presence of pericardial effusion can be associated with a higher risk of heart failure during admission, and patients with pericardial effusion may require closer monitoring and timely surgical intervention 5
- The diagnostic workup for pericardial effusion due to infection should be guided by the patient's clinical symptoms and signs, as well as the results of imaging and laboratory tests 2, 4, 3