Pericarditis laboratory studies: Difference between revisions

Jump to navigation Jump to search
Line 21: Line 21:


==Autoimmune Markers==
==Autoimmune Markers==
Following [[autoimmune]] markers may be checked in patients with recurrent or prolonged pericarditis:
Following [[autoimmune]] markers may be checked in patients with recurrent or prolonged [[pericarditis]]:
*[[Antistreptolysin O titer]]
*[[Antistreptolysin O titre]]
*[[Rheumatoid factor]] ([[RF]])
*[[Rheumatoid factor]] ([[RF]])
*[[Antinuclear antibody]] ([[ANA]])
*[[Antinuclear antibody]] ([[ANA]])

Revision as of 16:57, 29 November 2012

Pericarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

HIV
Post MI
Dressler's syndrome
Post-pericardiotomy
Radiation
Tuberculosis
Uremia
Malignancy

Differentiating Pericarditis from other Diseases

Epidemiology and Demographics

Screening

Natural History, Complications and Prognosis

Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Pericardiocentesis
Pericardial Window
Pericardial Stripping

Treatment Related Videos

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pericarditis laboratory studies On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Pericarditis laboratory studies

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pericarditis laboratory studies

CDC on Pericarditis laboratory studies

Pericarditis laboratory studies in the news

Blogs on Pericarditis laboratory studies

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pericarditis laboratory studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

Overview

Non-specific markers of inflammation are generally elevated in pericarditis. These include the leukocyte count, C-reactive protein, and ESR. The cardiac troponin is elevated if there is an injury to the underlying myocardium, a condition termed as myopericarditis. Diagnostic pericardiocentesis and biopsy help in identifying an underlying infectious or malignant process.

Inflammatory Markers

The following inflammatory markers are often elevated:

Cardiac Biomarkers

The following markers of myonecrosis may be elevated if there is involvement of the underlying myocardium:

Autoimmune Markers

Following autoimmune markers may be checked in patients with recurrent or prolonged pericarditis:

Gallium-67 Imaging

Gallium-67 scanning may help identify inflammatory and leukemic infiltrations.

Diagnositic Pericardiocentesis

Pericardial fluid should be aspirated and tested for presence of malignant cells and tumor markers particularly in patients with hemorrhagic effusion without preceding trauma[5]. However, hemorrhagic pericarditis in developing countries could be due to tuberculosis. Sensitivity of cytological analysis of pericardial fluid for malignant cells were 67%[6], 75%[7] and 92%[8] in different studies with specificity of 100%. Immunohistochemistry can be used to distinguish between the malignant cells and their possible origin[9][10].

Fluid aspirated can also be used for following tests:

Pericardial Biopsy

If the clinical suspicion of malignancy is high, and if the results of cytology testing from the pericardiocentesis are negative, consideration should be given to performing a pericardial biopsy. This can be performed via either a subxiphoid or transthoracic pericardiostomy or alternatively by pericardioscopy. An advantage of pericardioscopy is that it assists in the direct visualization of pericardium and collecting the biopsy sample. Pericardioscopy has an excellent sensitivity of 97%[7][11] which compares quite favorably to a blind biopsy which has a low sensitivity of 55-65%.

References

  1. Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
  2. Karjalainen J, Heikkila J (1986). ""Acute pericarditis": myocardial enzyme release as evidence for myocarditis". Am Heart J. 111 (3): 546–52. doi:10.1016/0002-8703(86)90062-1. PMID 3953365.
  3. Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". Eur Heart J. 21 (10): 832–6. doi:10.1053/euhj.1999.1907. PMID 10781355.
  4. Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R (2003). "Cardiac troponin I in acute pericarditis". J Am Coll Cardiol. 42 (12): 2144–8. doi:10.1016/j.jacc.2003.02.001. PMID 14680742.
  5. Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
  6. Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U (1991). "The diagnostic value of pericardial cytology. An analysis of 95 cases". Acta Cytol. 35 (2): 149–53. PMID 2028688.
  7. 7.0 7.1 Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
  8. Meyers DG, Meyers RE, Prendergast TW (1997). "The usefulness of diagnostic tests on pericardial fluid". Chest. 111 (5): 1213–21. PMID 9149572.
  9. Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW (2003). "Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block". Diagn Cytopathol. 28 (1): 1–5. doi:10.1002/dc.10219. PMID 12508174.
  10. Mayall F, Heryet A, Manga D, Kriegeskotten A (1997). "p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology". Cytopathology. 8 (1): 9–12. PMID 9068950.
  11. Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A; et al. (1996). "Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients". Circulation. 94 (7): 1635–41. PMID 8840855.

Template:WH Template:WS