Purpose Most of pericardial effusion associated with pericardial tamponade is nearly sanguineous fluid. However, there is no enough clinical data or information about hemopericaridum. The aim of this study is to exam whether amounts of RBC in pericardial effusion is useful in determining the cause of pericardial effusion.
Method We performed retrospective study for 132 patients (age=64짹14) who underwent therapeutic pericaridocentesis in university hospital since 2005. In this study, pericardial effusion was categorized into frank blood effusion, bloody effusion and non-bloody effusion according to amounts of RBC in pericardial effusion. Frank blood effusion was defined as a fluid involving RBC counts over the half of peripheral blood RBC counts. Bloody effusion and non-bloody effusion were classified with classic cut off value defined as RBC counts over 10⁵/���쨀. To evaluate role of RBC count on discriminating etiology of pericardial effusion, we also used another cut off value of bloody pericardial effusion defined as RBC counts over 10⁶/���쨀.
Result A leading causes of pericardial effusion were neoplastic (37%, n=50), mycobacterium tuberculosis (Tbc, 17%, n=28), uremic (7%, n=10) and idiopathic (6%, n=8) etiology. Frank blood effusion was shown in 35 patients (26%). Among the frank blood effusion patients, neoplastic (54%, n=19), uremic (11%, n=4), complications of acute myocardial infarction (11%, n=4), iatrogenic (11%, n=4) and aortic dissection (9%, n=3) were common causes. Approximately two third (56%, n=76) of all patients showed the bloody effusion. Among bloody effusion, neoplastic (51%, n=39), Tbc (9%, n=7) and uremic (9%, n=7) 9 were common causes of bloody effusion estimated by a classic cut off value such as in many previous studies. However when a new cut off value (over RBC counts 10⁶/���쨀) was adapted to our results, number of bloody effusion in Tbc (n/total=0/28 vs. 7/28, p=0.03) and idiopathic (n/total=0/8 vs. 2/8, p=0.01) were significantly decreased as compared with classic cut off value.
Conclusion This study revealed that there were many other etiologies of frank blood effusion beyond catastrophic etiologies, such as iatrogenic, aortic dissection and complication of myocardial infarction, to need further surgical or interventional treatment. Subsequently, even though pericardial effusion was frank blood effusion, it might not always imply catastrophic etiologies. In case of using new cut off value of bloody effusion, Tb and idiopathic etiologies were significantly decreased and could be ruled out in bloody effusion etiologies.