Q & A: Pericardial Effusion

Q. An adolescent patient of mine was recently hospitalized on a pediatric service for medical stabilization and was told that she has a pericardial effusion. How often does that occur, and how serious is it? (B.K., Nashville, TN)

A. Prior studies in the U.S. and Italy have demonstrated pericardial effusion in about 20% to 25% of adolescents with anorexia nervosa (AN) who required medical hospitalization for being severely underweight. According to Dr. Philip Mehler, who specializes in the treatment of severely ill adult patients with AN, pericardial effusion has not been a problem in the patients he’s seen (personal communication). A large case series of adolescents has recently been published from a child and adolescent psychiatry university department in Berlin (Eur Child Adolesc Psychiatry 2011; Nov 16. [Epub ahead of print]). In this study, 173 consecutively admitted adolescents (aged 12-17 years) with AN were compared to 40 healthy adolescent control subjects of the same age, but of normal weight. Clinically silent pericardial effusions were found in 34.7% of the patients but in none of the controls. Patients with pericardial effusion showed significantly lower initial body mass indexes (kg/m2), had more prominent low T3 syndrome, and had longer hospitalizations than patients without this finding. The pericardial effusion remitted in 88% of the patients after weight restoration. I’m not aware of long-term studies of out come or of the longer-term clinical implications for these patients.

— J.Y.