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September 14, 1984

Treatment of Pericardial Effusion With Local Corticosteroid Injections

Author Affiliations

University of Missouri Health Sciences Center Columbia

JAMA. 1984;252(10):1283. doi:10.1001/jama.1984.03350100017019

To the Editor.—  Dr Jacobs1 in his letter advocates local instillation of steroids for treatment of some pericardial effusions. Contrary to his statement, the method had been used before the report of Buselmeier et al2 in 1973. In 1969, we reported prolonged pericardial drainage with local instillations of small doses of hydrocortisone as a very successful technique in two uremic patients.3 Similar reports were published in the early 1970s.4 The method gained much popularity in the late 1970s after the first report in the American literature. However, this technique is not without a risk of introducing infection into the pericardium.5 Moreover, the value of intrapericardial steroids is doubtful, since excellent results have been reported by prolonged drainage alone6 and local steroids were always used in conjunction with drainage. Although I might be personally biased in favor of local steroids as a treatment of pericardial effusion,