LYMPH FLOW AND 131I-ALBUMIN RESORPTION FROM PERICARDIAL EFFUSIONS IN MAN

The characteristics of albumin movement across the pericardium were determined to clarify whether certain longstanding pericardial effusions were due primarily to decreased lymph drainage and albumin resorption rather than to increased capillary permeability and albumin leak. Albumin resorption from the pericardial space was studied in 9 patients with effusion of various origin. At the time of pericardiocentesis 131I-human serum albumin (RISA) was instilled into the pericardial space. Complete mixing was usually achieved by 15 minutes and the volume of the effusion was calculated by the indicator-dilution principle. Precordial scans of pericardial radioactivity delineated the effusion and verified the absence of fluid leak from the pericardial space into the pleural space. RISA disappeared from the pericardial space (determined by precordial scintillation counting) as a single exponential function. Half-times for such disappearance ranged from 49 hours to 15.5 days. Simultaneously the rate of appearance of RISA in blood varied directly with its disappearance from pericardial fluid. Total protein of the fluid was 5.1 ± 0.77(mean ± S.D.) gm./100 ml. (range 3.5 to 6.0) while the albumin concentration ranged from 1.6 to 3.0 gm./100 ml. (40 to 56 per cent of the total protein when determined by electrophoresis). Albumin resorption from the pericardial space was 1.86 ± 0.57 gm./day (mean ± S.D.) and ranged within relatively narrow limits (1.4 to 3.2 gm./day). Lymph flow draining the pericardial space averaged 82 ± 26 (± S.D.) ml./day (range 46 to 128) and bore little relation to the size of the effusion. Because of the narrow range of values for albumin resorption found in the patients studied, we were unable to identify any patient in whom lymphatic obstruction appeared to be a primary or major contributing factor in the development of pericardial effusion. © 1969.