Surgical Management of Pericardial Effusion of Non-cardiac Etiology: Etiologic Spectrum, Diagnostic Contribution, and Early Outcomes in a Single-Center Retrospective Case Series

Abstract

Background Pericardial effusion has many causes, ranging from inflammatory and infectious diseases to tuberculosis, malignancy, renal failure, autoimmune conditions, and systemic illness. Pericardiocentesis provides rapid relief of pericardial effusion. However, in certain non-cardiac etiologies, fluid analysis alone may be insufficient to establish the underlying diagnosis. Surgical drainage through pericardiotomy or pericardiectomy allows controlled evacuation and direct sampling of the pericardium, which can help establish the diagnosis and guide the treatment. Objective The main objective of this study is to describe the presentation, echocardiographic features, etiologic spectrum, surgical approaches, diagnostic contribution, and early outcomes of patients who underwent surgery for pericardial effusion at a tertiary referral center in a tuberculosis-endemic region. Methods We reviewed 15 consecutive adolescent and adult patients with moderate-to-large pericardial effusion treated surgically between January 2023 and December 2025. Demographics, presentation, echocardiographic findings, operative approach, microbiology, cytology, histopathology, length of stay, and in-hospital outcome were recorded and analyzed descriptively. We defined diagnostic contribution as any histopathologic, cytologic, microbiologic, or clinically integrated information from surgery that helped classify the etiology and the impact on management as a surgical finding that started, confirmed, or changed treatment. Results Median age was 45 years (interquartile range (IQR), 32-55; range, 15-83), and nine patients (60%) were women. Every patient was dyspneic, and 10 patients (66.7%) had cardiac tamponade or impending tamponade. The largest effusion dimension on echocardiography ranged from 16 to 50 mm. Six patients (40%) underwent subxiphoid pericardiotomy, eight (53.3%) underwent video-assisted thoracoscopic surgery (VATS) pericardiotomy, and one (6.7%) underwent VATS pericardiectomy. Surgical drainage was successfully completed in all patients and provided therapeutic decompression. Histology most often showed nonspecific chronic inflammation (11 patients (73.3%)). Specific histopathological diagnoses were obtained in 3 of 15 patients (20.0%): tuberculous pericarditis in one patient, tuberculous constrictive pericarditis in one patient, and metastatic adenocarcinoma in one patient. The remaining specimens showed nonspecific chronic inflammation or no specific pathological process. Median hospital stay was seven days (IQR, 6.5-8.5; range, 4-11). Two patients (13.3%) died during hospitalization; both had advanced systemic illness and preoperative tamponade physiology, and no death was attributed to a documented procedural complication. Conclusions Surgical drainage provided effective decompression and contributed to etiologic evaluation in selected patients with non-cardiac pericardial effusion. While specific histopathological diagnoses were uncommon, tissue sampling identified clinically important cases of tuberculosis and malignancy and provided a meaningful diagnostic contribution.