A case of malignant lymphoma, Rappaport histiocytic type, in which the initial clinical presentation was malignant pericardial effusion with cardiac tamponade is presented. [ncbi.nlm.nih.gov]

• 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]

  Relapsed Multiple Myeloma Presenting as Intracranial Plasmacytoma and Malignant Pericardial Effusion following Recent Allogeneic Stem Cell Transplantation. Case Rep Oncol. 2017 Jul 4;10(2):582-587. DOI: 10.1159/000478001. [multiplemyelomahub.com]

• Collapse

  Diastolic collapse of the right ventricular (RV) free wall (Panel C, arrow; and video ) and systolic collapse of the right atrial (RA) free wall (Panel D, arrow; and video ) were suggestive of cardiac tamponade physiology. [nejm.org]

  50 RA, RV, and LA collapse Severe circumferential effusion (30 mm), no hemodynamic compromise 15 22 RA and RV collapse Small circumferential effusion 16 20 RA and RV collapse Moderate circumferential effusion (17 mm) with partial collapse of right chambers [revespcardiol.org]

  This showed R atrial collapse and they did an emergent pericardiocentesis for pericardial tamponade. The patient was resuscitated but was deemed terminal and later died. No definitive treatment was directed at the lung cancer. [forums.acdis.org]

  Echocardiogram showing massive pericardial effusion (dashed line), floating heart, and collapsed right atrium and ventricle that are consistent with cardiac tamponade. Figure 4. [swjpcc.com]

  Large pericardial effusion, right atrial and ventricular diastolic collapse consistent with cardiac tamponade. Figure 2. Transthoracic echocardiogram. [mdpi.com]

• Fatigue

  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]

  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]

  Other symptoms may include: Fever Fatigue Muscle aches Shortness of breath Nausea, vomiting, and diarrhea (if you have a virus) When there’s no inflammation of the sac, there are often no symptoms. [webmd.com]

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

• Lymphadenopathy

  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]

  A CT angiogram revealed a moderate-sized pericardial effusion (Figure 1) and supraclavicular and mediastinal lymphadenopathy with no evidence of a pulmonary embolus. Ultrasound confirmed a moderate pericardial effusion with no evidence of tamponade. [advancedpractitioner.com]

  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]

  CT brain showed a left parietal lobe metastasis and staging CT found mediastinal lymphadenopathy, two enhancing liver lesions, left pleural and pericardial effusion. [mdpi.com]

  [Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration combined with Surepath liquid-based cytology test for lung lesions and mediastinal lymphadenopathy]. [jbiomed.com]

• 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]

  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]

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

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

• Aspiration

  For the first time we describe our algorithm of Transbronchial PE Aspiration (TPEA) by the usage of a regular EBUS-TBNA needle aspiration controlled by C-arm and regular transthoracic ultrasound. [jbiomed.com]

  RESULTS: The mean total volume of the aspirated effusion fluid was 782 +/- 264 mL (range, 400-1200 mL). The drainage catheter was successfully removed in all patients, and the mean duration of pericardial drainage was 7.7 +/- 2.7 d (range, 5-13 d). [ncbi.nlm.nih.gov]

  Fine-needle aspiration biopsy of the left cervical lymph node revealed adenocarcinoma. At the 15-month follow-up, the patient was continuing to receive chemotherapy for non–small-cell lung cancer. [nejm.org]

  Procedure: A spinal needle was introduced under the xiphoid process, and directed posteriorly toward the tip of the left scapula until the pericardial space was entered and fluid aspirated. Bloody pericardial fluid was aspirated. [cathlabdigest.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]

• Sputum

  0.8mg % SGOT – 34 IU/L SGPT – 26 IU/L Protein – 5.5 gm/L Albumin 3.5 gm/L HIV – non reactive HBs Ag - neg HCV – neg CRP – 57.14 mg/L TSH – 0.33 mic/dl Total T3 – 96 mic/dl Total T4 – 7.8 mic/dl ANA – negative RA – negative Pleural fluid ADA – 10 U/L Sputum [slideshare.net]

• 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]

• 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]

  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]

  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]

• 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]

  […] treatment for dangerous arrhythmia 2019 Outstanding Clinician Award Electrocardiography of the dog and the cat Seattle (WA) – ACVIM Forum 2018 Henry and Karen Silverman Initiative to Advance Treatment of Canine Arrhythmias INCESSANT MONOMORPHIC VENTRICULAR TACHYCARDIA [robertosantillimedvet.it]

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

• Cardiomegaly

  An anteroposterior chest radiograph showed cardiomegaly (Panel A). [nejm.org]

  Panel A: Cardiomegaly with water bottle shape shown before procedure. Panel B: resolution after drainage of 1.8 L of pericardial fluid. Figure 3. [swjpcc.com]

  In cases where effusions are recurrent and symptomatic (e.g. malignancy) then pericardial fenestration can be performed. hemopericardium : has higher attenuation on CT and often a different clinical context cardiomegaly : can sometimes mimic an effusion [radiopaedia.org]

  Chest Radiography Cardiomegaly occurs if there is more than 250 mL of fluid in the pericardial sac ( Figure 7A ). [clevelandclinicmeded.com]

• Thrombosis

  Newer technique of pericardioperitoneal shunt insertion was developed in the hope of achieving improved palliation. [12] Though the procedure was simple and effective, it is commonly associated with shunt thrombosis and recurrence of effusion. [12], [ [jpalliativecare.com]

  Primary malignant pericardial mesothelioma—a rare cause of superior vena cava thrombosis and constrictive pericarditis. Journal of Thoracic Disease. [mesothelioma.com]

• 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]

• Suggestibility

  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]

  Diastolic collapse of the right ventricular (RV) free wall (Panel C, arrow; and video ) and systolic collapse of the right atrial (RA) free wall (Panel D, arrow; and video ) were suggestive of cardiac tamponade physiology. [nejm.org]

• Irritability

  CONCLUSION: (1) Intrapericardial minocycline instillation is very effective in preventing recurrence of malignant pericardial effusion. (2) Minocycline is irritative to the pericardium and may cause severe chest pain with transient ECG changes, suggesting [ncbi.nlm.nih.gov]

  Phrenic nerve irritation can cause hiccups. With a small effusion, the physical examination is unremarkable. [clevelandclinicmeded.com]

(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]

• 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]

Subxiphoid pericardial fenestration is the treatment of choice. Patients who will not receive systemic treatment should be managed conservatively. [ncbi.nlm.nih.gov]

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

Etiologic diagnosis was based on pericardial fluid and epicardial biopsy analysis by cytology, histology, immunohistochemistry, microbiology and polymerase chain reaction. [ncbi.nlm.nih.gov]

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

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]

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]

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]

This intervention is performed with local anesthesia, is effective in preventing reaccumulation, and has a low morbidity. Conclusions. [jamanetwork.com]