28C / 246 – RISK FACTORS OF PLEURO-PERICARDIAL EFFUSION AMONG PEDIATRIC PATIENTS
WITH INITIAL PRESENTATION OF PLEURAL EFFUSION ALONE AND PERICARDIAL EFFUSION ALONE
AT PHILIPPINE HEART CENTER.
MS Damian1, MNA De Leon1, MS Bautista1, TS De Guia2.
1Philippine Heart Center Pulmonary and Critical Care Medicine, Pediatric Pulmonology - Quezon City,
Philippines
2Philippine Heart Center Pulmonary and Critical Care Medicine, Adult Pulmonology - Quezon City, Philippines
Objective: To determine the incidence and different factors leading to pleuropericardial effusion among
pediatric patients with initial presentation of pleural effusion or pericardial effusion alone.
Materials and Methods: A retrospective chart review of 0-19 years old pediatric patients admitted to our
institution during a 9-year period with diagnosis of either Pleural effusion /Pericardial effusion and eventually
developed pleuropericardial effusion as documented by echocardiogram, and chest radiograph was done. All
demographic, clinical, radiographic, and laboratory data of these patients were collected and analyzed with
the chi square and Mann-Whitney test. A p value of 0.005 was considered significant.
Results: Included were 179 patients, of which, 91 (51%) with pleural effusion and 88 (49%) with pericardial
effusion. Significant finding were, 73 (41%) had pleuropericardial effusion and were older at 11.71 years
(p=0.006), had initial presentation of pericardial effusion, (p=0.000), highly associated with Acquired Heart
Disease, 54 (74%), and Tuberculosis, 33 (45%),
(p-value=0.000). They have low normal PF ratio=373 (p= 0.020), low pleural fluid protein 3.5 g/dl
(p=0.000), low pericardial fluid glucose 57 mg/dl (p=0.000) and high pericardial fluid to serum LDH
ratio, 3.61 (p=0.031). They have large sized, exudative, infectious in origin effusions (p-value = 0.000)
and with increased incidence of surgical intervention. A high serum and pericardial fluid LDH , high
pericardial fluid WBC and lymphocytes with low pericardial protein although not significant, showed a
trend towards predicting possibility of pleuropericardial effusion. Dyspnea, 26 (36%) and Cough 23 (32%)
were the most common symptoms noted.
Conclusion: We found a high incidence of pleuropericardial effusions in pediatric patients with pericardial
effusions associated with newly diagnosed acquired heart diasease and Tuberculosis. Low normal PF ratio,
low pleural fluid protein, low pericardial fluid glucose and high pericardial fluid to serum LDH ratio,
with large sized, exudative, infectious in origin effusions and a propensity for surgical intervention suggest
a prognostic relationship between pleural and pericardial effusions to the development of pleuropericardial
effusion. The majority of these pleuropericardial collections resolve with treatment of the underlying pleural and
pericardial disease.