Purulent pericarditis

Q: Purulent pericarditis is defined as?

A) >20 leukocytes per oil immersion field
B) Only if gross pus is present in the pericardium
C) EKG finding consistent with acute pericarditis
D) High glucose level in the pericardial fluid 
E) Low Protein level in the pericardial fluid


Answer: A

Gross presence of pus in the pericardium is diagnostic but is not the only requirement for purulent pericarditis (choice B). Microscopically, the presence of >20 leukocytes per oil immersion field is the threshold for diagnosis (choice A). EKG finding consistent with acute pericarditis (choice C) supports the diagnosis of purulent pericarditis but does not confirm it. Glucose level is usually low (choice D) and protein level is usually high (choice E) in purulent pericarditis.

#cardiology
#infectiousdiseases 



References:

1. Rubin RH, Moellering RC Jr. Clinical, microbiologic and therapeutic aspects of purulent pericarditis. Am J Med 1975; 59:68. 

2. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921.