Maisch B, Ristić A D
Fachbereich Medizin der Philipps-Universität Marburg, Feldbergstr. 45, 35043, Marburg, Deutschland,
Herz. 2014 Nov;39(7):837-56. doi: 10.1007/s00059-014-4167-1.
This article describes the diagnostics, differential diagnostics, multimodal imaging, medicinal and invasive diagnostic therapy of acute and chronic pericarditis, constrictive pericarditis, pericardial effusion and cardiac tamponade under etiological aspects and on the basis of the guidelines of the European Society of Cardiology (ESC). The starting point of the decision tree is the symptomatic patient with echocardiographic evidence of pericardial effusion. The principle feature of the diagnostics is the etiopathogenetic allocation of the pericardial disease which influences the clinical picture, course therapy and prognosis. Infectious pericarditis (e.g. viral, bacterial and tuberculous) is differentiated from sterile autoreactive pericarditis and from neoplastic pericardial effusion by the cytology of the effusion and immunohistological and molecular investigations of the pericardial and epicardial biopsies. Pericardioscopy plays an important role in the recognition of suspicious areas. In many cases intrapericardial administration of cisplatin for neoplastic pericardial effusion and instillation of triamcinolone for autoreactive pericarditis prevent recurrence just as a treatment of several months with colchicine.
本文依据欧洲心脏病学会（ESC）的指南，从病因学角度描述了急慢性心包炎、缩窄性心包炎、心包积液和心脏压塞的诊断、鉴别诊断、多模态成像、药物及侵入性诊断治疗。决策树的起点是有超声心动图证据显示心包积液的有症状患者。诊断的主要特征是心包疾病的病因病理分类，这会影响临床表现、病程治疗及预后。通过积液的细胞学检查以及心包和心外膜活检的免疫组织学和分子研究，可将感染性心包炎（如病毒性、细菌性和结核性）与无菌性自身反应性心包炎及肿瘤性心包积液区分开来。心包镜检查在识别可疑区域方面发挥着重要作用。在许多情况下，对于肿瘤性心包积液心包内注射顺铂以及对于自身反应性心包炎滴注曲安奈德可预防复发，就如同使用秋水仙碱治疗数月一样。
