Etiological Profile of Pericardial effusion in Kashmir: A Study from Northern India
Authors: *1Dr Irfan Yaqoob, D.M, 2Dr Khursheed A. Khan, D.M, 3Dr Jahangir R. Beig, D.M, 4Dr Irfan A. Bhat, D.M, 5Dr Nisar A. Tramboo, D.M, 6Dr Imran Hafeez, D.M, 7Dr Aijaz A. Lone, D.M, 8Dr Sumera Samreen
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Pericardial effusion is one of the common diseases presenting in emergency and outpatient departments of a tertiary care center. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases known to cause it. Although there is abundant literature regarding the clinical and etiological profile of pericardial effusion and cardiac temponade in developed countries, it remains under reported in developing countries like India. This study was conducted to assess the etiological spectrum of pericardial effusion in northern India. This single center observational study included 102 patients presenting as moderate to severe pericardial effusion over a period of two years from March 2012 to February 2014. Iatrogenic and post traumatic cases were excluded. The diagnosis of pericardial effusion was established by echocardiography, seen as echo-free space (representing pericardial fluid) surrounding the heart , more than 10 mm deep in front of the right ventricle and beyond the left ventricle. Evaluation for the cause of PE included complete blood count with ESR, Blood urea, serum creatinine, tuberculin skin test, Chest X-ray, QuantiFERON TB-GOLD, Thyroid profile, ANA, Rheumatoid factor and imaging (CT chest or MRI). Pericardiocentesis and pericardial fluid analysis was done only in patients who were in temponade and those who had persistent/recurrent effusion extending beyond three months. Final diagnosis was based on history, examination and specific laboratory investigations. The major cause of pericardial effusion is tuberculosis (24.5%) followed by malignancy (16.6%), uremia (15.6%) and acute pericarditis (idiopathic/viral)(14.7). Other causes of significant pericardial effusion are collagen vascular disease (5.8%), hypothyroidism (3.9%), CCF (3.9), myocardial infarction (2.9), pyogenic infection (1.9%), mediastinal irradiation (1.9%) and HIV infection (1.9%). Six patients (5.8%) had significant effusion of more than three months duration in whom no cause could be established. The etiological profile of pericardial effusion in developing country differs from what is seen in developed countries. Tuberculosis is the most common cause in our study in contrast to studies from the developed region where malignancy remains the leading cause.
Keywords: Pericardial effusion; Temponade; Etiology; Pericarditis; Tuberculosis.