心膜液貯留の診断基準に関する研究

抄録

Up to the present time pericardial effusion has been diagnosed by assessing the findings on chest X-ray, ECG, heart sound, arterial pressure, venous pressure and paradoxical pulse altogether. However, the diagnosis has been not always accurate enough.
Consequently, the author has attempted to set diagnostic criteria by combining the recently developed methods, such as cardiac pool scanning and echocardiogram with the traditionally employed examinations, such as cardiothoracic ratio and paradoxical pulse, which have been thought to provide the important information of this disease.
A discriminatory formula for cardiothoracic ratio was derived by means of principal component analysis. By this formula pericardial effusion was correctly diagnosed in 72.4% of the cases. For this purpose, the measurements of the cardiothoracic ratio on admission and one week after the admission were necessary. The paradoxical pulse more than 10 mmHg was seen in 84.6% of the cases with pericardial effusion. The pressure difference of 8.10 mmHg according to respiration was found to be used also as a positive sign of paradoxical pulse, provided that the findings obtained from other methods were taken into consideration. The free space existing between the cardiac and hepatic areas was observed in 94.1% of the cases with pericardial effusion, indicating that this is more informative than other indicators for cardiac pool scanning.
Although echocardiogram was positive in all cases with pericardial effusion, positive result was obtained also in 15% of the cases without pericardial effusion. In other words, the probability for false positivity was not small. The accumulated volume of pericardial fluid estimated from echocardiographic parameters well corresponded to the volume actually measured at surgery or autopsy.
From these results, the following conclusions may be drawn. Positive findings in more than three out of four examinations mentioned above indicate the definite accumulation of pericardial effusion. When there were two positive findings, it was not possible to decide whether or not there was pericardial effusion, except when there were positive findings in paradoxical pulse and echocardiogram or in cardiac pool scanning and echocardiogram. In the latter two cases, it was possible to diagnose as having pericardial effusion. When all the four examinations were negative, the absence of the effusion was indicated.