[CHARACTERISTICS OF LARGE PERICARDIAL EFFUSION IN A WELL-DEFINED GEOGRAPHICAL REGION].

BACKGROUND: Pericardial effusion can occur as a result of primary pericardial disease or secondary to systemic disease. Analysis of the features of pericardial effusion in correlation with clinical and demographic findings can help clinicians to determine the correct diagnosis and to choose the appropriate treatment and reduce patient mortality and morbidity. METHODS: Retrospective analysis of the characteristics of pericardial effusion and the prevalence of the different etiologies and their correlation with demographics, clinical characteristics and medical history in 86 patients admitted to Galilee Medical Center from 2001 to 2010 who underwent pericardiocentesis or pericardial window. RESULTS: The most common etiology was idiopathic - 36% of cases, followed by cancer - 31.4%, coronary artery disease - 16.3%, renal failure - 4.6%, trauma - 4.6%, autoimmune disease - 4.6%, cirrhosis of liver - 1.2% of cases and hypothyroidism with 1.2% of cases. Laboratory tests rarely contributed to the diagnostic process; the most common symptom was dyspnea (76.6%). Most of the effusions were exudates (70.9%), and use of anti-coagulants increased the tendency to develop a bloody effusion (p=0.031). Idiopathic etiology, coronary heart disease or renal failure were more frequent in Arabs (58%, 57% and 75%, respectively) than in Jews (42%, 43% and 25%, respectively). In contrast, Jews had more malignant effusion (67% Jews and 33% Arabs). The average age of patients of all etiologies, except for trauma, was > 60 years (only 7% of patients were under the age of 17 years); the idiopathic etiology was mainly exudative (50%), compared with a transudative effusion in which coronary heart disease was most common (46%). CONCLUSIONS: The spectrum of etiologies of large symptomatic pericardial effusion in a community hospital in the Western Galilee region in the contemporary era is continuously evolving. Currently, the most frequent etiology is idiopathic, followed by malignancy. Routine laboratory testing rarely affects the pre-pericardiocentesis diagnosis.