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Bloody Pericardial Effusion : Clinically Significant Without Intrinsic Diagnostic Specificity

David H. Spodick, MD, DSc, FCCP; , MA
Author and Funding Information

Dr. Spodick is Professor of Medicine, University of Massachusetts Medical School; and is also affiliated with the Cardiovascular Division, Saint Vincent Hospital.

Correspondence to: David H. Spodick, MD, DSc, FCCP, Saint Vincent Hospital, 25 Winthrop St, Worcester, MA 01604



Chest. 1999;116(6):1506-1507. doi:10.1378/chest.116.6.1506
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Extract

Bleeding in any tissue is always concerning and potentially serious, either as a marker of disease or of potential blood loss. Hemopericardium (Table 1 ) comprises sanguineous pericardial effusions (which do not clot), frank blood due to wounds, and rupture into the pericardium of cardiovascular structures. The latter usually overwhelms the fibrinolytic and anticlotting activities of the pericardial mesothelium1 and therefore usually clots. In cases of frank bleeding, the cause is frequently manifest or rapidly becomes so. Bloody pericardial effusion, on the other hand, is diagnostically more challenging because of the wide variety of conditions that simultaneously produce fluid (mostly exudates) and various degrees of bleeding into it, presumably from irritated capillaries. Contemporary experience indicates the very broad range of effusions, including common viral pericarditides, that may exhibit sanguineous pericardial effusion,2 in contrast to the time-dishonored teachings about the frequency of life-threatening underlying lesions, notably tuberculosis. With the exception of AIDS patients, tuberculosis has been disappearing, at least in the industrialized Western world. Of course, diagnostic specificity is heavily related to the prevalence of any disorder in a given population, and the skewed populations of referral centers and institutions, which have developed populations of particular kinds of patients, will reflect this.


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