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Clinical Investigations: CARDIOLOGY |

Role of Biochemical Tests in the Diagnosis of Large Pericardial Effusions*

Lesley J. Burgess, PhD; Helmuth Reuter, MRCP; J. J. Frans Taljaard, MD; Anton F. Doubell, PhD
Author and Funding Information

*From the Departments of Chemical Pathology (Drs. Burgess and Taljaard) and Cardiology (Drs. Reuter and Doubell), University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.

Correspondence to: Lesley J. Burgess, PhD, Department of Cardiology, University of Stellenbosch and Tygerberg Hospital, PO Box 19174, Tygerberg 7505, South Africa; e-mail: treadres@iafrica.com



Chest. 2002;121(2):495-499. doi:10.1378/chest.121.2.495
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Study objectives: To determine the biochemical characteristics of large pericardial effusions in various disease states, and to assess their utility as diagnostic tools.

Setting: An academic university hospital in the Western Cape, South Africa.

Design: Consecutive, prospective case series.

Patients: One hundred ten hospital patients > 12 years old, who presented to the echocardiography department with large pericardial effusions, and 12 control subjects who underwent open-heart surgery (coronary artery bypass graft or aortic valve replacement).

Measurements: Fluid was sent for examination of biochemistry, adenosine deaminase, microbiology, hematology, and cytology. The etiology of each pericardial fluid sample was established using predetermined criteria.

Results: The biochemistry of pericardial exudates differed significantly from pericardial transudates. Light’s criteria (whereby an exudate is defined as having one or more of the following: pleural fluid/serum protein ratio > 0.5; pleural fluid/serum lactate dehydrogenase [LDH] ratio > 0.6; and/or pleural fluid LDH level > 200 U/L) were applied to pericardial fluids and demonstrated to be the most reliable diagnostic tool for identifying pericardial exudates. The corresponding sensitivity was 98%.

Conclusion: Although laboratory tests are a useful guideline when assessing the etiology and pathophysiology of pericardial effusions, the majority of large, clinically significant pericardial effusions result from exudative causes.


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