Du Bois sign

Du Bois sign is a clinical sign that is indicative of pericarditis, a condition characterized by inflammation of the pericardium, the fibrous sac surrounding the heart. This sign is named after the American physician Eugene Du Bois, who described it. Du Bois sign is observed as a systolic retraction in the intercostal spaces, primarily in the left lower sternal border, which is a result of the adherent pericardium pulling on the chest wall during heart contraction.

Etiology

Pericarditis can be caused by a variety of factors including infections (viral, bacterial, fungal), autoimmune diseases, cancer, kidney failure, and heart surgery. The inflammation leads to the production of excess fluid or the development of fibrous scar tissue, which can cause the pericardium to adhere to the heart or chest wall, manifesting in signs such as Du Bois sign.

Pathophysiology

The pathophysiology behind Du Bois sign involves the inflammatory process of the pericardium, which leads to the formation of adhesions between the pericardium and the pleura or diaphragm. During systole, when the heart contracts, these adhesions pull on the chest wall, causing the characteristic retraction observed in Du Bois sign. This sign is a physical manifestation of the pathological changes occurring within the pericardium and its surrounding structures.

Clinical Presentation

Patients presenting with Du Bois sign may also exhibit other symptoms of pericarditis, including chest pain that may improve when sitting up and leaning forward, fever, shortness of breath, and a pericardial friction rub heard upon auscultation. The presence of Du Bois sign, along with these symptoms, can aid in the diagnosis of pericarditis.

Diagnosis

The diagnosis of pericarditis, and the observation of Du Bois sign, is primarily clinical but can be supported by various diagnostic tools. Echocardiography is the most useful imaging technique, as it can detect pericardial effusion and other abnormalities. Electrocardiogram (ECG) changes and elevated inflammatory markers in the blood, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), can also support the diagnosis.

Treatment

Treatment of pericarditis, and thereby the resolution of Du Bois sign, focuses on addressing the underlying cause and relieving symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and pain. In cases where pericarditis is caused by bacterial infection, antibiotics are prescribed. For more severe cases, corticosteroids or colchicine may be used to reduce inflammation. In cases where there is significant pericardial effusion or constriction, surgical intervention may be necessary.

Prognosis

The prognosis for patients with pericarditis varies depending on the underlying cause. Most cases of acute pericarditis have a good prognosis with appropriate treatment. However, recurrent or chronic pericarditis can lead to complications such as constrictive pericarditis or cardiac tamponade, which require more aggressive treatment and may have a more guarded prognosis.

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