Forty-six years after the first description of cholesterol pericarditis, little is known of its causation or pathogenesis. Clinicians have always been intrigued by the shimmering-satiny beauty which the presence of cholesterol crystals imparts to the pericardial fluid, and the term coined by Alexander1 in 1919, "fluid of gold paint appearance," has been retained as a particularly apt phrase. There have been reports of approximately 50 patients in whom chronic pericardial effusions contained high cholesterol concentrations. Brawley, Vasko, and Morrow2 have recently described two such patients; their analysis of these subjects and of previously published reports provides clinically significant guidelines. These investigators sought particularly to answer the question: Is this a specific form of pericardial disease as has been generally assumed, or does it rather represent a nonspecific response to injury?
The average cholesterol concentration found in these patients was 245 mg/100 cc. (Cholesterol values above 70 mg/100 cc