Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (43 page)

   Tuberculosis coronary arteritis occurs mainly in patients with preexisting pericardial or myocardial tuberculosis.

   Syphilitic arteritis can involve the first 3–4 mm of the left and right coronary arteries with an obliterative arteritis.

   When a nonviral infectious angiitis occurs, it is almost always accompanied by myocarditis with abscesses and pericarditis.

   Laboratory Findings

   Core lab blood work, cultures, and PCR analysis should be dictated by systemic clues to the underlying infectious process.

THROMBOPHLEBITIS, SEPTIC

   Definition

   Thrombophlebitis is vascular inflammation due to a blood clot.

   Laboratory Findings

Findings are due to associated septicemia, complications (e.g., septic pulmonary infarction), and underlying disease.

   Hematology: increased WBC count (often >20,000/μL), with marked shift to left and toxic changes in neutrophils. DIC may be present.

   Core laboratory: azotemia.

   Culture: positive blood culture (
Staphylococcus aureus
is the most frequent organism; others are
Klebsiella, Pseudomonas aeruginosa
, enterococci,
Candida
).

PERICARDITIS (ACUTE) AND PERICARDIAL EFFUSION

   Definition

   The pericardium is a double-walled sac that surrounds the heart. The inner visceral pericardium is normally separated from the outer, fibrous parietal pericardium by a small volume (15–50 mL) of fluid, a plasma ultrafiltrate. Inflammation of the pericardium results in pericarditis, with or without an associated pericardial effusion.