Pericardial effusion: Deciding when to perform pericardial drainage and pericardial biopsy

AFB: acid-fast bacilli; CMV: cytomegalovirus; MI: myocardial infarction; PCR: polymerase chain reaction; TB: tuberculosis.

* Refer to UpToDate content on diagnosis of cardiac tamponade.

¶ Purulent pericarditis is rare life-threatening illness and is generally manifested by fever, often with evidence of sepsis.

Δ In a patient with known malignancy and pericardial effusion, pericardial sampling and drainage is not required unless it is needed to treat or reduce the risk of cardiac tamponade or for cancer staging.

◊ In selected cases with accessible pericardial fluid, percutaneous pericardiocentesis may be performed as a temporizing measure during preparation for surgical drainage.

§ When performing pericardial biopsy, pericardioscopic guidance with extensive pericardial sampling may enhance the diagnostic yield, particularly for malignancy, purulent pericarditis, or radiation-induced pericarditis.

¥ The decision to obtain a pericardial biopsy is made in the context of other clinical assessments, including imaging and laboratory tests. In patients with suspected malignancy, this includes determining access to, safety, and anticipated yield of potential biopsy sites. In patients with high clinical suspicion of TB and/or in a TB-endemic area, a pericardial biopsy is not generally required.