New nonsurgical technique for multiple pericardial biopsies

Our plain-English summary of New nonsurgical technique for multiple pericardial biopsies, by J. Endrys, M. Simo, M.Z. Shafie, et al (Catheterization and Cardiovascular Diagnosis, 1988).

The study

• Authors: J. Endrys, M. Simo, M.Z. Shafie, B. Uthaman, Y. Kiwan, T. Chugh, S.M. Ali, K. Spacek, A.M. Yousef, G. Cherian
• Journal: Catheterization and Cardiovascular Diagnosis
• Published: 1988;15(2):92-4
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a new, nonsurgical technique for obtaining multiple pericardial biopsies in patients with pericardial effusion. A short catheter is introduced by the Seldinger technique under fluoroscopy through the subxiphoid approach. The pericardial fluid is aspirated and the catheter replaced by an 8F teflon sheath with a curved tip. A bioptome is inserted through the sheath, and air is allowed to enter the pericardium. This method outlines the parietal percardium. The curved sheath directs the bioptome to the left or right wall. Eighteen consecutive patients had an average of eight pieces of pericardium removed. On histological examination, three patients had malignancy. Six had tuberculous granuloma, and mycobacterium tuberculosis was cultured from all six tissue specimens but only once from the fluid. Tissue smears showed acid fast bacilli in four out of six, whereas the fluid was negative in all. The biopsy yielded diagnostic information in nine out of ten patients with a thickened pericardium. There were no complications.

In plain English

This article described a new way to take tissue samples from the pericardium (the sac around the heart) without surgery, in patients with fluid around the heart. Working from just below the breastbone under X-ray guidance, the doctors drained the fluid, passed a curved tube into the sac, let air in to outline its outer layer, and used a biopsy instrument to take several small pieces. The authors, from institutions in Kuwait and Czechoslovakia, used the method in 18 consecutive patients, taking an average of eight pieces from each. Tissue examination gave a definite diagnosis in nine of the 18 patients: tuberculosis in six, mesothelioma in one and carcinoma in two. In the six tuberculosis patients, tuberculosis bacteria grew from the tissue in all six but from the fluid only once. The biopsy gave diagnostic information in nine of ten patients whose pericardium was thickened. No complications were reported. The authors concluded that biopsy may not give useful information when the pericardium is not thickened. The article did not discuss asbestos or any patient's exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Report of a new nonsurgical biopsy technique, with results from a consecutive series of patients (case series)
• Who was studied: 18 consecutive patients with pericardial effusion who needed the fluid drained for tamponade or for diagnosis. The authors were from institutions in Kuwait and Czechoslovakia. The article does not say where or when the patients were treated.
• Main results:
  • Satisfactory tissue samples were obtained in all 18 patients, an average of eight pieces each.
  • Tissue examination gave a definite diagnosis in nine of the 18 patients: tuberculosis in six, mesothelioma in one and carcinoma in two.
  • In the remaining nine patients, tissue examination did not give a diagnosis but excluded tuberculosis or malignancy. One had lupus erythematosus, one had a myxedema effusion, and seven had nonspecific changes.
  • In the six tuberculosis patients, a positive culture and tuberculous granuloma were found in the tissue of all six. Tissue smears showed acid-fast bacilli in four of the six.
  • Mycobacterium tuberculosis was cultured from the pericardial fluid in only one of the six tuberculosis patients.
  • In the three patients with malignancy, cytology of the pericardial fluid was positive in two.
  • The biopsy gave diagnostic information in nine of the ten patients with a thickened pericardium.
  • There were no complications. Two patients with thin pericardium reported a 'pulling' feeling in the chest during the biopsies.
  • Before biopsy, tuberculosis had been suspected in only two of the six tuberculosis patients, and malignancy in two of the three malignancy patients.
• The authors' conclusion: The authors concluded that biopsy may not give useful information in patients whose pericardium is not thickened. They reported that they now biopsy patients with large chronic effusions of unclear cause, particularly if tuberculosis or malignancy is suspected.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Pericardial Effusion, Pericardium, Granuloma, Biopsy.

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