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Malignant Pericardial Effusion
Pericardial Effusion Malignant

Presentation

The clinical presentation, histology, and survival of these patients is compared with those cases published prior to 1974. Survival of patients with primary malignancy in the lung who present with malignant pericardial effusion has not improved. [ncbi.nlm.nih.gov]

Entire Body System

  • Large Pericardial Effusion

    Abstract Patients with cardiac tamponade or large malignant pericardial effusion, who survived longer than 30 days after withdrawal of catheter from the pericardial space, entered the study. [ncbi.nlm.nih.gov]

    Computed tomographic imaging of the chest (Panel B) revealed a large pericardial effusion (asterisk), a lung mass in the left lower lobe, and necrotic-appearing left supraclavicular lymphadenopathy. [nejm.org]

    Large pericardial effusion and moderate bilateral pleural effusions. Figure 1. Computed tomography (CT) chest axial view. Large pericardial effusion and moderate bilateral pleural effusions. 3. [mdpi.com]

Respiratoric

  • Dyspnea

    Six patients had exertional dyspnea and 13 had dyspnea at rest; three needed emergency pericardiocentesis. An average of 740 ml of fluid was recovered; cytology was diagnostic in 11 cases and histopathology in 10 cases. [ncbi.nlm.nih.gov]

  • Cough

    A 52-year-old woman with stage IV ovarian adenocarcinoma presented with worsening cough, dyspnea, and fatigue. Chest X-ray and echocardiogram confirmed the presence of pericardial effusion with cardiac tamponade. [ncbi.nlm.nih.gov]

    Symptoms may arise gradually or rapidly, depending on fluid accumulation rate, and may range from dyspnoea, chest pain, cough, palpitations and orthopnoea, to fatigue, anxiety and confusion. [oncologypro.esmo.org]

    Symptoms of malignant pericardial effusion include shortness of breath, cough, chest pain, and edema. [swjpcc.com]

    I have a patient with stage 4 lung cancer that presented with fatigue, cough, and loss of appetite. Initially they thought he had PNA but when they did an ECHO on day one they found a pericardial effusion (malignant). [forums.acdis.org]

    Q: I have a patient with Stage 4 lung cancer that presented with fatigue, cough, and loss of appetite. [hcpro.com]

  • Orthopnea

    With progression of constrictive pericarditis, symptoms of right-sided heart failure (eg, peripheral edema, nausea, abdominal discomfort, ascites) become apparent and usually precede signs of left-sided failure (eg, exertional dyspnea, orthopnea, paroxysmal [clevelandclinicmeded.com]

Gastrointestinal

  • Dysphagia

    Other symptoms arise from the compression of surrounding structures (lung, stomach, phrenic nerve) or diastolic heart failure and include chest pressure or pain, dyspnea, nausea, abdominal fullness, and dysphagia. [clevelandclinicmeded.com]

Liver, Gall & Pancreas

  • Hepatomegaly

    Problems Fever – low grade 15 days B/L pleural effusion more on Left side Pericardial Effusion Ascites Hepatomegaly On ATT. 9. [slideshare.net]

    On evaluation, radiology revealed right adrenal mass with periportal, periaortic and aortocaval lymphadenopathy, mild hepatomegaly with fatty liver and cardiac tamponade with bilateral pleural effusion and minimal ascites. [article.sciencepublishinggroup.com]

Cardiovascular

  • Chest Pain

    Minocycline instillation was associated with severe chest pain in seven patients, and with ECG changes suggesting pericardial or subepicardial injury in two patients. [ncbi.nlm.nih.gov]

    Symptoms may arise gradually or rapidly, depending on fluid accumulation rate, and may range from dyspnoea, chest pain, cough, palpitations and orthopnoea, to fatigue, anxiety and confusion. [oncologypro.esmo.org]

    In the clinical assessment of pericardial effusion, the absence of hallmark features (chest pain, friction rub, fever, characteristic EKG findings) has been associated with a greater likelihood of MPE. [shmabstracts.com]

    Pericardial effusion - the buildup of fluid in the sac Cardiac tamponade - a serious problem in which buildup of fluid in the sac causes problems with the function of the heart Symptoms of pericardial problems include chest pain, rapid heartbeat, and [icdlist.com]

  • Tachycardia

    The odds ratios for cardiac tamponade in PE were 3.7 (95% confidence interval [CI]: 1.65-8.30) for low-voltage complexes, 12.3 (95% CI: 1.58-95.17) for electrical alternans, and 4.9 (95% CI: 2.22-10.80) for sinus tachycardia. [ncbi.nlm.nih.gov]

    EKG showed sinus tachycardia, low QRS voltage with electric alternans (Figure 1), and chest x-ray demonstrated cardiomegaly with a water bottle shaped heart (Figure 2A), suggesting pericardial effusion. [swjpcc.com]

    Malignant involvement of the pericardium oroccasionally treatment of malignancy can cause pericardial effusion.Pericardial effusion can be asymptomatic or cause chest discomfort,dyspnea, tachycardia, hypotension and cardiogenic shock, with increasingamount [nebraska.pure.elsevier.com]

    At physical examination, tachycardia, decreased heart sounds, neck vein distension, peripheral oedema and pericardial friction rubs may be present. [oncologypro.esmo.org]

    Figure 1 Figure 1: Noted tachycardia and low voltage criteria in all derivations on the ECG strip of the patient. [ispub.com]

Workup

(See Presentation, Workup, Treatment, and Medication .) This image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film. [emedicine.medscape.com]

Other ECG Findings

  • Electrical Alternans

    The odds ratios for cardiac tamponade in PE were 3.7 (95% confidence interval [CI]: 1.65-8.30) for low-voltage complexes, 12.3 (95% CI: 1.58-95.17) for electrical alternans, and 4.9 (95% CI: 2.22-10.80) for sinus tachycardia. [ncbi.nlm.nih.gov]

    EKG showed sinus tachycardia, low QRS voltage with electric alternans (Figure 1), and chest x-ray demonstrated cardiomegaly with a water bottle shaped heart (Figure 2A), suggesting pericardial effusion. [swjpcc.com]

    At initial evaluation, a chest radiograph may provide evidence of an enlarged cardiac silhouette, while at electrocardiography (ECG) low-voltage complexes and electrical alternans are suggestive of pericardial effusion. [oncologypro.esmo.org]

    ECG Sinus tachycardia Normal axis Low voltage complexes No electrical alternans No ST –T changes 13. Radiography CXR AP VIEW 14. [slideshare.net]

    Abnormal findings on ECG include tachycardia, electrical alternans ( Figure 9 ), low voltage, and may include changes associated with acute pericarditis ( Figure 6 ). [clevelandclinicmeded.com]

Treatment

Several methods of treatment have been reported with an overall response rate of approximately 75%. [ncbi.nlm.nih.gov]

Prognosis

Leukemic and lymphatic tumors have better prognosis. [ncbi.nlm.nih.gov]

Etiology

A patient was diagnosed with widely metastatic cervical cancer following a simple hysterectomy for presumed benign etiology. [ncbi.nlm.nih.gov]

Etiology, treatment and prognosis of large pericardial effusions. A study of 34 patients. Chest, 100 (1991), pp. 985-987 [2.] E.W. Hancock. Neoplastic pericardial disease. Cardiol Clin, 8 (1990), pp. 673-682 [3.] K.K. Wong, A.K. Li. [archbronconeumol.org]

No other test was diagnostic for a specific etiology. [scienceopen.com]

Epidemiology

In Cardiac Tamponade: Epidemiology, Causes and Management (pp. 91-112). Nova Science Publishers, Inc.. [nebraska.pure.elsevier.com]

Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Annals of Epidemiology, 27(5):348-359. doi: 10.1016/j.annepidem.2017.04.001 Nambiar, C. et al. (1992). Primary pericardial mesothelioma: One-year event-free survival. [asbestos.com]

Carbone Mesothelioma epidemiology, carcinogenesis, and pathogenesis [16] T. Butz, L. Faber, C. Langer Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report [17] M. [elsevier.pt]

Occurrence in the United States Few large studies have characterized the epidemiology of pericardial effusion; however, the available data consistently show that pericardial effusion is more prevalent than is clinically evident. [emedicine.medscape.com]

Pathophysiology

A patient with recurrent squamous cell carcinoma of the cervix causing symptomatic pericardial effusion is presented, and the incidence, mechanism, pathophysiology, treatment, and outcomes of malignant pericardial effusion in patients with gynecologic [ncbi.nlm.nih.gov]

Staging of Alberto de Hoyos 2177 Less Common Malignant Tumors of the Diagnostic Investigation of Mediastinal 2195 The Use of Prosthetic Grafts to Replace 195 Poorly Differentiated Carcinoma of the Mediastinum 2411 2261 Benign and Malignant Neurogenic 2415 Pathophysiology [books.google.com]

Pathophysiology Clinical manifestations of pericardial effusion are highly dependent on the rate of accumulation of fluid in the pericardial sac. [emedicine.medscape.com]

Pathophysiology The initiating event results in a chronic inflammatory pericardial process, resulting in fibrinous scarring and occasionally calcification of the pericardium ( Figure 10 ). [clevelandclinicmeded.com]

The pathophysiology is thought to be predominantly through regional lymphatic invasion, and less commonly, direct mediastinal invasion and hematogenous spread [ 5 ]. [mdpi.com]

Prevention

This intervention is performed with local anesthesia, is effective in preventing reaccumulation, and has a low morbidity. [ncbi.nlm.nih.gov]

Since outcome is usuallypoor, goal of treatment is palliation of symptoms and prevention ofrecurrence of effusion. [nebraska.pure.elsevier.com]

Extended catheter drainage after pericardiocentesis, percutaneous balloon pericardiotomy, and various other surgical approaches are also possible options to prevent recurrence. [current-oncology.com]

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