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Purulent pericarditis

Massimo Imazio, MD, FESC
Section Editors
Stephen B Calderwood, MD
Martin M LeWinter, MD
Deputy Editors
Brian C Downey, MD, FACC
Elinor L Baron, MD, DTMH


Prior to the widespread use of antibiotics, purulent pericarditis was a frequent complication of pneumococcal pneumonia. In modern times, most cases of purulent pericarditis are associated with nosocomial bloodstream infections (such as in the setting of dialysis), thoracic surgery, or immunosuppression (eg, HIV, chemotherapy).

Galen (AD 129 – 217) was one of the first clinicians to recognize and attempt to treat purulent pericarditis. While removing the "putrefied" sternum of a patient with posttraumatic pericarditis, he directly observed "mortification of the pericardium" in a patient who survived [1].

By the beginning of the 19th century, clinicians were aware that purulent fluid collections in the pericardium could occur in patients with pneumonia and pleurisy, and were attempting treatment with percutaneous drainage and pericardiectomy [2].

Issues related to purulent pericarditis will be reviewed here. Other causes of pericarditis and the management of acute pericarditis are discussed separately. (See "Etiology of pericardial disease" and "Acute pericarditis: Clinical presentation and diagnostic evaluation" and "Acute pericarditis: Treatment and prognosis".)


Purulent pericarditis is defined as a localized infection of the pericardial space characterized by gross pus in the pericardium or microscopic purulence (>20 leukocytes per oil immersion field). This distinction is important since purulent material in the pericardium is not synonymous with infectious pericarditis, and not all infections produce purulent effusions. As an example, pericarditis due to Mycoplasma hominis or viral infection is rarely macroscopically or microscopically purulent. By contrast, a variety of noninfectious conditions produce an inflammatory exudate that may contain >50,000 white cells/microL [3].

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Literature review current through: Nov 2017. | This topic last updated: Nov 23, 2015.
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