Purulent pericarditis: review of a 20-year experience in a general hospital

Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.

OBJECTIVES. The purpose of this study was to review the features of purulent pericarditis in patients from a general hospital during a recent 20-year period. BACKGROUND. Although studies published from 1974 to 1977 suggested a changing spectrum for purulent pericarditis, this view has not been proved. METHODS. We retrospectively evaluated the records of 33 patients from one general hospital who had a diagnosis of purulent pericarditis during the period 1972 to 1991. All autopsy protocols from the same period were also reviewed. In 19 patients (group I), the condition was diagnosed during life; in 14 (group II), it was identified at autopsy. RESULTS. In group I, the possible sources of pericardial infection were identified in 17 patients; pneumonia (6 patients) was the most common source. Empyema was present in 10 patients; 15 had cardiac tamponade. The most common microorganisms were streptococci, pneumococci and staphylococci. Six patients developed constrictive pericarditis and required pericardiectomy. Three patients died, 1 patient was lost to follow up and 15 patients had a favorable outcome at a mean follow-up interval of 35 months. In group II, the clinical diagnoses included pneumonia (five patients) among other infections, with empyema in six patients. Purulent pericarditis was probably the direct cause of death in two patients. CONCLUSIONS. In our experience, the spectrum of purulent pericarditis has not changed in recent years. Many patients do not have the classical findings of pericarditis, and diagnosis is made only at autopsy or after tamponade has developed. Empyema remains a common predisposing condition. Purulent pericarditis is still a severe disease, but its prognosis is excellent in patients who can be discharged from the hospital.

This article has been cited by other articles:

				N. W. C. J. van de Donk, R. C. A. Meijer, Y. G. C. J. America, and M. J. Cramer Staphylococcus aureus pericardial abscess presenting as a localized bulge of the heart contour Interact CardioVasc Thorac Surg, May 1, 2010; 10(5): 818 - 819. [Abstract] [Full Text] [PDF]

				J. Soler-Soler and J. Sagrista-Sauleda CHAPTER 19 Pericardial Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				M. Imazio, E. Cecchi, B. Demichelis, S. Ierna, D. Demarie, A. Ghisio, F. Pomari, L. Coda, R. Belli, and R. Trinchero Indicators of Poor Prognosis of Acute Pericarditis Circulation, May 29, 2007; 115(21): 2739 - 2744. [Abstract] [Full Text] [PDF]

				G. Leoncini, L. Iurilli, A. Queirolo, and G. Catrambone Primary and secondary purulent pericarditis in otherwise healthy adults Interact CardioVasc Thorac Surg, October 1, 2006; 5(5): 652 - 654. [Abstract] [Full Text] [PDF]

				Task Force members, B. Maisch, P. M. Seferovic, A. D. Ristic, R. Erbel, R. Rienmuller, Y. Adler, W. Z. Tomkowski, G. Thiene, M. H. Yacoub, et al. Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Eur. Heart J., April 1, 2004; 25(7): 587 - 610. [Full Text] [PDF]

				M. Imazio, B. Demichelis, I. Parrini, M. Giuggia, E. Cecchi, G. Gaschino, D. Demarie, A. Ghisio, and R. Trinchero Day-hospital treatment of acute pericarditis: A management program for outpatient therapy J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1042 - 1046. [Abstract] [Full Text] [PDF]

				G Permanyer-Miralda Acute pericardial disease: approach to the aetiologic diagnosis Heart, March 1, 2004; 90(3): 252 - 254. [Full Text] [PDF]

				M. H. Kim, G. D. Abrams, P. G. Pernicano, and K. A. Eagle Sudden Death in a 55-Year-Old Woman With Systemic Lupus Erythematosus Circulation, July 21, 1998; 98(3): 271 - 275. [Full Text] [PDF]