The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 408-412, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A clinicopathological study of post-thoracotomy purulent pericarditis. A continuing problem of diagnosis and therapy
BH Bulkley, PG Klacsmann and GM Hutchins
Cardiac infections after operations are infrequent but, when present, are
often fatal. The 14 autopsied patients in whom purulent pericarditis
developed after thoracic operations over an 88 year period at The Johns
Hopkins Hospital were studied. Purulent pericarditis developed after
cardiac operations in 10 and after pulmonary resections in 4. In 12 of the
14 cases the pericardial sac had been opened. Associated postoperative
infection, present in 13 patients, included mediastinitis in 7 and empyema
in 3. Staphylococcus was the infection organism in half of the patients.
Associated cardiac infection, including endocarditis, myocardial abscess,
and graft infection, was present in 5 (36 per cent) patients. Death
occurred within 2 months of operation in 11 (79 per cent) patients; it was
due to infection in 9, cardiac tamponade in 4, and arrhythmias and heart
failure in one. The diagnosis of purulent pericarditis was made before
death in only 5 (36 per cent) cases, in part owing to masking of the usual
signs of pericarditis in the postoperative patient. Since the introduction
of antibiotics, the over-all incidence of purulent pericarditis has
decreased. However, pericardial infection after thoracotomy has increased
tenfold, and patients undergoing cardiac operations in particular provide a
new and increasing population at risk for this disease.
