The role of serial echocardiography in the evaluation and differential diagnosis of pericardial disease.

Echocardiography is an established method for the diagnosis of pericardial effusion. Echographic findings in fibroadhesive disease have also been described. The interpretation of a changing serial echogram during the clinical course of pericardial disease has not been established. Sixteen patients with echographic evidence of pericardial effusion were followed with serial echographic studies. In seven, surgical or autopsy correlation was obtained. Because of the serial changes noted we undertook a study in dogs to clarify the problem of variability in intensity of sound reflected from the pericardial space. Three open-chested dogs were studied with rapid sequence surface echograms as blood introduced into the pericardial space was converted from the unclotted to the clotted state. In all three dogs blood clooting increased the intensity or sound reflected from the pericardial space. Our study of two patients with fibroadhesive pericardial disease documents serial changes in echoes from the pericardium and pericardial space accompanying the clinical evolution of the disease process, and suggests a method for avoiding the commonly encountered difficulty in proper identification of the pericardial and epicardial echoes. Our preliminary studies suggest that serial echograms should play an important role in the management of patients with pericardial effusion; further surgical/pathological correlations are required.