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Malignant Pericardial Effusion


Presentation

  • Only twenty-nine cases of extracellular malignancies with this initial presentation have been previously published.[ncbi.nlm.nih.gov]
  • 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]
  • Recommendations for management are presented, stressing radiation therapy and other local measures following initial pericardiocentesis.[ncbi.nlm.nih.gov]
  • Malignant pericardial effusion should be included in the differential diagnosis in patients with recurrent ovarian cancer who present with cardiac tamponade.[ncbi.nlm.nih.gov]
  • One patient presented with cardiac tamponade; the other had diffuse cutaneous involvement of the left neck and shoulder two months before he presented with cardiac tamponade. Cytologic examination of both fluids revealed adenocarcinoma.[ncbi.nlm.nih.gov]
Large Pericardial Effusion
  • Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and no other interventions directed to the pericardium were required.[ncbi.nlm.nih.gov]
  • pericardial effusion caused by advanced non-small cell lung cancer.[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]
  • Treatment was considered as successful when recurrence of symptoms of large pericardial effusion was not observed in ECG and other interventions directed to the pericardium were not required.[ncbi.nlm.nih.gov]
  • pericardial effusion was observed on a CT thorax; fluid analysis of the cardiac tamponade revealed CD138-positive plasma cells At this stage, the patient was kept comfortable with hospice care and died 1 month later This is an unusual presentation of[multiplemyelomahub.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]
  • The only common clinical feature shared by the patients was dyspnea.[ncbi.nlm.nih.gov]
  • Sixteen months later, she was diagnosed with pericardial tumor involvement and a malignant pericardial effusion resulting in severe dyspnea. The patient underwent a pericardial window procedure that temporarily alleviated her symptoms.[ncbi.nlm.nih.gov]
  • 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]
  • A 46-year-old woman underwent modified radical mastectomy in April 1997 and was readmitted to the hospital for dyspnea in March 2002.[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]
  • On review of systems, she reported a 3-month history of a progressive cough and a 3-week history of hoarseness with progressive shortness of breath (SOB) and difficulty speaking.[advancedpractitioner.com]
  • A 53-year-old woman complained of cough and dyspnea for months before consultation. The chest X-rays and computed tomography revealed a well-defined mass in the left middle mediastinum with necrotic changes and calcification within it.[slideshare.net]
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]
Hepatomegaly
  • Problems Fever – low grade 15 days B/L pleural effusion more on Left side Pericardial Effusion Ascites Hepatomegaly On ATT. 9.[slideshare.net]
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]
  • Fever and chest pain were experienced in six and five patients, respectively, but were controlled with antipyretics.[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]
  • Symptoms of malignant pericardial effusion include shortness of breath, cough, chest pain, and edema.[swjpcc.com]
Tachycardia
  • 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]
  • 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]
  • At physical examination, tachycardia, decreased heart sounds, neck vein distension, peripheral oedema and pericardial friction rubs may be present.[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]

Workup

Electrical Alternans
  • 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]
  • 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]
  • 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

  • Subxiphoid pericardial fenestration is the treatment of choice. Patients who will not receive systemic treatment should be managed conservatively.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To discuss the diagnosis and treatment of malignant pericardial effusion and focus on quantitating the success and complication rates of the many treatment modalities and updating recent advances in the field.[ncbi.nlm.nih.gov]
  • Ultrasound reviews performed 4 weeks after treatment showed that 71 cases achieved complete remission and eight cases achieved partial remission, while treatment was completely ineffective in two cases.[ncbi.nlm.nih.gov]
  • Efficacy of investigated treatment was assessed also in the group of patients with survival longer than 30 days. Safety of treatment was assessed in the whole group of patients.[ncbi.nlm.nih.gov]
  • Thoracotomy, pericardial window and intrapericardial mitoxantrone instillation appear to constitute effective treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Leukemic and lymphatic tumors have better prognosis.[ncbi.nlm.nih.gov]
  • Although multiple treatment options exist, prognosis is poor and usually limited.[ncbi.nlm.nih.gov]
  • Early diagnosis of the specific cause is not only useful but also essential in determination of the mode of therapy and estimation of prognosis.[ncbi.nlm.nih.gov]
  • An individual treatment plan should be established, taking into account cancer stage, the patient's prognosis, local availability and experience.[ncbi.nlm.nih.gov]
  • CONCLUSION: Diagnosis of a pericardial effusion as malignant carried an ominous prognosis: 86% of patients died within the first year and nearly one-third within the first month.[ncbi.nlm.nih.gov]

Etiology

  • Etiologic diagnosis was based on pericardial fluid and epicardial biopsy analysis by cytology, histology, immunohistochemistry, microbiology and polymerase chain reaction.[ncbi.nlm.nih.gov]
  • A patient was diagnosed with widely metastatic cervical cancer following a simple hysterectomy for presumed benign etiology.[ncbi.nlm.nih.gov]
  • Malignant etiology of the pericardial fluid was confirmed by cytological examination. Subsequently, cisplatin (10 mg in 20 mL normal saline) was instilled into the pericardial space.[ncbi.nlm.nih.gov]
  • Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients.[ncbi.nlm.nih.gov]
  • Malignant etiology of pericardial fluid was confirmed by cytological examination and/or by echocardiography. The diagnosis of malignancy was based upon histological examination of samples obtained from primary tumor.[ncbi.nlm.nih.gov]

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]
Sex distribution
Age distribution

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 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]
  • This treatment was effective in preventing reaccumulation of the pericardial effusion until her death.[ncbi.nlm.nih.gov]
  • The tumour deposits elsewhere in the body continued to progress and eventually killed the patient, but drainage and one dose of intrapericardial bleomycin prevented further episodes of pericardial effusion.[ncbi.nlm.nih.gov]
  • CONCLUSION: Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade, and cisplatin instillation prevents recurrence.[ncbi.nlm.nih.gov]
  • 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]

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