Flexible fiberoptic pericardioscopy for the diagnosis of pericardial disease

Pericardiocentesis provides an etiologic diagnosis for pericardial effusions approximately 25% of the time. In seven patients with evidence of a large pericardial effusion of unknown origin without cardiac tamponade, a flexible fiberoptic bronchoscope was inserted through a subxiphoid incision after the effusion was drained. Pericardioscopy allowed visualization of all pericardial surfaces and made it possible to perform selective biopsy not limited to a subxiphoid window. It is a safe procedure that can permit distinction among benign, malignant and tuberculous origins of pericardial effusion.