This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giacomo Leoncini Giuseppe Catrambone Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Leoncini, G. Articles by Catrambone, G. Search for Related Content PubMed PubMed Citation Articles by Leoncini, G. Articles by Catrambone, G. Related Collections Mediastinum Pleura Pericardium

Primary and secondary purulent pericarditis in otherwise healthy adults

Unit of Thoracic Surgery, San Martino University Hospital, Genoa, Italy

*Corresponding author. U. O. di Chirurgia Toracica, Azienda Ospedaliera Universitaria ‘San Martino’, L.go R. Benzi 10, 16132 Genova, Italy. Tel.: +39-0105552336; fax: +39-0105556799.

E-mail address: giacomo.leoncini{at}hsanmartino.it (G. Leoncini).

The records of five previously healthy adult patients with primary and secondary purulent pericarditis are reported, in order to review the literature about such a rare condition and to discuss the options for treatment. Primary purulent pericarditis occurred in a five months pregnant woman and in a lady who had experienced a serous pericarditis two months before. A man presented with pyo-pneumo-pericardium. He had an episode of acute prostatitis 30 days before. Two further patients had purulent pericarditis secondary to pulmonary and mediastinal infections. The diagnosis was made late in all cases, after tamponade and shock occurred. Pre-operative catheter drainage failed to prevent recurrent tamponade and sepsis in two patients. All patients underwent thoracotomy and partial pericardiectomy. A downward transdiaphragmatic spreading collection was evident in one patient and laparotomy was needed. The mean postoperative stay was 30.4 days (20–48 days). All patients were discharged home in good health. The lady who was pregnant experienced an uncomplicated vaginal delivery. The follow-up time ranged between 5 months to 12 years. No patient has signs of pericardial constriction. We conclude that effective control of sepsis and prevention of possible further constriction are achieved safely by open surgical drainage and partial pericardiectomy.

Key Words: Purulent pericarditis; Subxiphoid pericardial drainage; Pericardiectomy; Intrapericardial thrombolysis