Abstract
Purulent pericarditis is a collection of purulent effusion in the pericardial space. It has become a rare entity with the increased availability and use of antibiotics. In contrast to pleural empyema, there are few data regarding the biochemical parameters of purulent pericardial effusion to aid diagnosis. Therefore, in this study, we have evaluated the diagnostic utility of biochemical tests in patients with purulent pericarditis. Between September 2004 and September 2012, we treated fifteen children with purulent pericarditis and tamponade. There were 8 boys and 7 girls, ranging in age from 8 months to 14 years, with a mean age of 5.3 ± 3.2 years. Echocardiographic diagnosis of cardiac tamponade was made in all patients. All patients underwent immediate surgical drainage due to cardiac tamponade. The diagnosis of purulent pericarditis was supported by biochemical tests. Anterior mini-thoracotomy or subxiphoid approach was performed for surgical drainage. The most common clinical findings were tamponade, hepatomegaly, tachycardia, fever refractory antibiotic therapy, dyspnea, tachypnea, cough, and increased jugular venous pressure. Central venous pressure decreased and arterial tension increased immediately after the evacuation of purulent effusion during operation in all patients. The pericardial effusion had high lactic dehydrogenase, and low glucose concentration, confirming purulent pericarditis. Also, pH (mean± SD) was 7.01 ± 0.06. The culture of pericardial effusions and blood samples were negative. Biochemical tests are useful guideline when assessing the pericardial effusions. However, these tests should be interpreted with the clinical and operative findings.
Highlights
Purulent pericarditis is a collection of purulent effusion in the pericardial space
Biochemical analysis was remarkable for pericardial effusion lactate dehydrogenase (LDH) values that were greater than 1000 IU/L in all samples
Results of all biochemical parameters were in favor of purulent pericarditis
Summary
Purulent pericarditis is a collection of purulent effusion in the pericardial space. It has become a rare entity with the increased availability and use of antibiotics. Purulent pericarditis is a rare entity in the developed countries. It generally presents with acute cardiovascular decompensation and a sepsislike appearance.[4] The postulated pathophysiology has been that the adjacent pleuropulmonary infection may cause an inflammatory response in the pericardium with migration of neutrophyls and eventual deposition of fibrin.[5] Since the pericardial space is only rarely the initial site of infection, identification of the primary focus is mandatory. It is most often a result of the spread of a contiguous pulmonary, intracardiac, or chest wall infection.[6]
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