Pericarditis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]

Diagnostic Study of Choice

Study of choice

[Name of the investigation] is the gold standard test for the diagnosis of [disease name].

OR

The following result of [gold standard test] is confirmatory of [disease name]:

• [Result 1]
• [Result 2]

OR

[Name of the investigation] must be performed when:

• The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
• A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.

OR

[Name of the investigation] is the gold standard test for the diagnosis of [disease name].

OR

The diagnostic study of choice for [disease name] is [name of the investigation].

OR

There is no single diagnostic study of choice for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].

OR

[Disease name] is primarily diagnosed based on the clinical presentation.

OR

Investigations:

• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.

The comparison of various diagnostic studies for [disease name]

Test	Sensitivity	Specificity
Test 1	...%	...%
Test 2	...%	...%

[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

Diagnostic results

The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:

• [Finding 1]
• [Finding 2]

Sequence of Diagnostic Studies

The [name of investigation] must be performed when:

• The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
• A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:

• [Initial investigation]
• [2nd investigation]

Name of Diagnostic Criteria

It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:

• Criteria 1
• Criteria 2
• Criteria 3

OR

IF there are clear, established diagnostic criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

IF there are no established diagnostic criteria

There are no established criteria for the diagnosis of [disease name].

2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)

Recommendations for the general diagnostic work-up of pericardial diseases

Class I

1. In all cases of suspected pericardial disease a first diagnostic evaluation is recommended with: – auscultation – ECG – transthoracic echocardiography – chest X-ray – routine blood tests, including markers of inflammation (i.e., CRP and/or ESR), white blood cell count with differential count, renal function and liver tests and myocardial lesion tests (CK, troponins). 2. CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis. 3. Pericardiocentesis or surgical drainage are indicated for cardiac tamponade or suspected bacterial and neoplastic pericarditis. 4. Further testing is indicated in high-risk patients (defined as above) according to the clinical conditions. (Level of Evidence: C)

Class I

It is recommended to search for independent predictors of an identifiable and specifically treatable cause of pericarditis (i.e. bacterial, neoplastic, systemic inflammatory diseases). Major factors include: – fever >38 C – subacute course (symptoms developing over several days or weeks) – large pericardial effusion (diastolic echo-free space >20 mm in width) – cardiac tamponade – failure of Aspirin or NSAIDs (Level of Evidence: B)

Class IIb

Percutaneous or surgical pericardial biopsy may be considered in selected cases of suspected neoplastic or tuberculous pericarditis. (Level of Evidence: C)

Recommendations for diagnosis of acute pericarditis

Class I

1. ECG is recommended in all patients with suspected acute pericarditis. 2. Transthoracic echocardiography is recommended in all patients with suspected acute pericarditis. 3. Chest X-ray is recommended in all patients with suspected acute pericarditis. 4. Assessment of markers of inflammation (i.e. CRP) and myocardial injury (i.e. CK, troponin) is recommended in patients with suspected acute pericarditis. (Level of Evidence: C)

Recommendations for the diagnosis and management of pericarditis associated with myocarditis

Class I

1. In cases of pericarditis with suspected associated myocarditis, coronary angiography (according to clinical presentation and risk factor assessment) is recommended in order to rule out acute coronary syndromes. 2. Cardiac magnetic resonance is recommended for the confirmation of myocardial involvement. 3. Hospitalization is recommended for diagnosis and monitoring in patients with myocardial involvement. 4. Rest and avoidance of physical activity beyond normal sedentary activities is recommended in non-athletes and athletes with myopericarditis for a period of 6 months. (Level of Evidence: C)

Class IIa

Empirical anti-inflammatory therapies (lowest efficacious doses) should be considered to control chest pain. (Level of Evidence: C)

Recommendations for the diagnosis of constrictive pericarditis

Class I

1. Transthoracic echocardiography is recommended in all patients with suspected constrictive pericarditis. 2. Chest X-ray (frontal and lateral views)with adequate technical characteristics is recommended in all patients with suspected constrictive pericarditis. 3. CT and/or CMR are indicated as second-level imaging techniques to assess calcifications (CT), pericardial thickness, degree and extension of pericardial involvement. 4. Cardiac catheterization is indicated when non-invasive diagnostic methods do not provide a definite diagnosis of constriction. (Level of Evidence: C)

Recommendations for the diagnosis and therapy of viral pericarditis

Class IIa

For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered. (Level of Evidence: C)

Class III

1. Routine viral serology is not recommended, with the possible exception of HIV and HCV. 2. Corticosteroid therapy is not recommended in viral pericarditis. (Level of Evidence: C)

Recommendations for the diagnosis of purulent pericarditis

Class I

1. Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis. 2. It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. (Level of Evidence: C)