Treatment of Pericardial Effusion With Local Corticosteroid Injections-Reply

In Reply.—  I am grateful to Dr Twardowski for calling to my attention his report of intrapericardial injections of corticosteroids as a treatment for uremic pericarditis, which no doubt led others later to try to perfect and popularize this method. However, he is not correct when he states that "local steroids were always used in conjunction with drainage." In the references we cited for treatment of tamponade caused by rheumatoid pericarditis, the patients were treated with aspiration and instillation of deposteroids alone, without prolonged drainage. We are also aware of a report of similar management to avoid prolonged drainage or pericardectomy in tamponade from other causes.¹ Those authors concluded, "We feel that hemodynamically significant uremic pericardial effusions should be treated first by pericardiocentesis and intrapericardial instillation of triamcinolone hexacetomide. We would reserve pericardiectomy for those cases in which loculations prevent adequate aspiration of the effusion or in which tamponade