Echocardiographic and clinical findings of massive pericardial effusion in medical patients

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, tachycardia, 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 echocardiography showed right atrial collapse in 19 of the 29 patients with tamponade, and in 3 of the remaining 22 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 diseases. Two-dimensional echocardiography was a good noninvasive diagnostic tool to detect the presence of pericardial effusion and cardiac tamponade.