Percutaneous pericardial biopsy: technique, efficacy, safety, and value in the management of pericardial effusion in children and adolescents.

This study describes our technique of nonsurgical percutaneous pericardial biopsy (PPB), its efficacy and safety, and its diagnostic and therapeutic usefulness in the management of pericardial effusion (PE) in children and adolescents. In an 8-year period, 19 selected patients, aged 2 to 20 years, had PPB for evaluation and treatment of PE. Using this procedure we procured multiple biopsy specimens from various areas of the thickened parietal pericardium, and also procured pericardial fluid for investigation. The biopsy material helped establish a specific etiologic diagnosis in 63% and helped exclude tuberculosis and malignancy in the rest (37%). The histopathologic diagnoses were tuberculous pericarditis (37%), uremic pericarditis (16%), radiation pericarditis (5%), connective tissue disease (5%), and idiopathic pericarditis (37%). In tuberculous pericarditis, the biopsy specimen provided an immediate histopathologic diagnosis, and a higher culture positivity (71%) than pericardial fluid (29%). In addition, the procedure was therapeutically effective in relieving tamponade and in treating effusion. Our experience indicates that the PPB procedure has both diagnostic and therapeutic value, and it can be performed easily, safely, and without complications even in small children.