Pericardial involvement in neoplastic disease

ESC CardioMed ◽  
2018 ◽  
pp. 1585-1587
Author(s):  
Dor Lotan ◽  
Yehuda Adler
Keyword(s):  
Pericardial Effusion ◽  
Gold Standard ◽  
Diagnostic Tests ◽  
Poor Prognosis ◽  
Pericardial Fluid ◽  
Neoplastic Disease ◽  
Large Pericardial Effusion ◽  
Life Threatening ◽  
Pericardial Involvement

Pericardial layer involvement in cancer patients is not rare and varies from malignant processes to therapy side effects (e.g. local irradiation). Primary pericardial masses are rare—mesothelioma being the most common—and have a poor prognosis. Secondary metastases to the pericardium form the majority of pericardial neoplasms with lung carcinoma being the most prevalent. Patients with neoplastic involvement of the pericardium may present with pericardial effusion that can deteriorate to life-threatening cardiac tamponade which carries a very poor prognosis. Diagnosis of neoplastic involvement of the pericardium is of clinical significant but carries diagnostic challenges. Symptoms such as dyspnoea or chest pain are not specific and diagnosis is usually incidental through imaging studies or diagnosed at a late stage when large effusions are present. In cases of large pericardial effusion or repetitive effusion with unknown aetiology, further investigation is advised by drainage of pericardial fluid (pericardiocentesis) for diagnostic purposes and relief of symptoms. Different diagnostic tests performed on pericardial fluid exist in practice with cytology and pathology as the gold standard, but may fail to detect neoplastic cells in some cases. Although carrying a poor prognosis, pericardial investigation and treatment should be considered in patients with suspected pericardial involvement and may prolong and improve quality of life, especially if detected early.

scholarly journals P1262 If anything can go wrong, it will: management of a pericardial effusion in a young patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J P Dias Ferreira Reis ◽  
T Mendonca ◽  
T Mano ◽  
G Portugal ◽  
P Silva Cunha ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pericardial Effusion ◽  
Accessory Pathway ◽  
Pericardial Fluid ◽  
Nucleic Acid Amplification ◽  
Right Atrial ◽  
Oral Steroid ◽  
Large Pericardial Effusion ◽  
Increased Risk ◽  
Oncologic Patients

Abstract Case Report A 25 year-old male patient with an unremarkable past medical history presented to the Emergency Department due to a hemodynamically stable wide complex tachycardia at 260bpm with no response to adenosine, which was successfully treated with synchronized electrical cardioversion. Post cardioversion EKG revealed a pre excitation pattern and the transthoracic echocardiogram showed a large pericardial effusion with diastolic right atrial collapse. The patient was admitted in the Cardiology Department for emergent pericardiocentesis and further investigation. A total of 800 mL of bloody pericardial fluid was removed, compatible with an exudate, but fluid culture and cytology were inconclusive. Due to a rapid reaccumulation of pericardial fluid, the patient underwent a pericardial window, after which he developed an intractable pleuritic thoracalgia, refractory to the combination of ibuprofen, colchicine and oral steroid, despite the resolution of the pericardial effusion. He was also submitted to an electrophysiologic study with successful ablation of a right sided accessory pathway. Analysis of the pericardial fluid and biopsy were inconclusive once again, including a low level of adenosine deaminase and negative acid-fast bacilli test and nucleic acid amplification test for Mycobacterium tuberculosis. The patient was afebrile and denied any constitutional symptoms or relevant epidemiological context. The remainder etiological study was unremarkable, with the exception of fluctuating antibody titers for adenovirus, Borrelia burgdorferi and Mycoplasma pneumoniae, which were interpreted as a result of cross-reactivity. Nevertheless, a course of 21 days of doxycycline was tried without any significant improvement. Thoracic-abdominal-pelvic CT and PET scan were normal. Direct inoculation in guinea pig led to positive results for Mycobacterium tuberculosis and antituberculous therapy was started. Despite pathogen directed antibiotic treatment, there was no clinical improvement and the pericardial effusion gradually relapsed, evolving to cardiac tamponade requiring emergent drainage. Histologic examination of pericardial fragments finally revealed massive infiltration by an undifferentiated malignant tumor compatible with a malignant epithelioid hemangioendothelioma. Due to the patient’s poor performance status and rapidly deteriorating clinical course, it was decided not to start chemotherapy. The patient eventually died, 6 months after his admission to the ED and 2 weeks after the neoplasm’s diagnosis. Conclusion In regions with a high Tuberculosis incidence, there should be a high degree of suspicion for tuberculous pericarditis, especially in cases of recurrent pericardial effusion. Immunosuppressed individuals, such as oncologic patients, are at an increased risk for tuberculosis. The management of relapsing pericardial effusion remains a diagnostic challenge as described in this clinical case.

scholarly journals Mechanical Cardiac Tamponade as an Initial Presentation of Malignant Lymphoma: Case Report

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Maha Bouziane
Keyword(s):  
Case Report ◽  
Malignant Lymphoma ◽  
Cardiac Tamponade ◽  
Medical History ◽  
Pericardial Fluid ◽  
Initial Presentation ◽  
Neoplastic Disease ◽  
Mediastinal Lymphoma ◽  
Cardiac Filling ◽  
Pericardial Involvement

Cardiac tamponade results from an accumulation of pericardial fluid under pressure, leading to impaired cardiac filling and haemodynamic compromise. In malignant lymphoma, cardiac and pericardial involvement, even though relatively uncommon, can be one early manifestations of this neoplastic disease. We describe a case of a 21 year old female with no medical history, whose first presentation for mediastinal lymphoma was a mechanical cardiac tamponade.

scholarly journals Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate?

2020 ◽  
Author(s):  
Hassan H Allam ◽  
Abdulhalim Jamal Kinsara ◽  
Tareq Tuaima ◽  
Shadwan Alfakeh
Keyword(s):  
Lactate Dehydrogenase ◽  
Pericardial Effusion ◽  
Pericardial Fluid ◽  
Case Description ◽  
Limited Information ◽  
Additional Insight ◽  
Laboratory Findings ◽  
Large Pericardial Effusion ◽  
Insight Into ◽  
High Lactate

Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.

Diagnostic Utility of Cyfra 21-1 and Cea Assays in Pericardial Fluid for the Recognition of Neoplastic Pericarditis

2005 ◽  
Vol 20 (1) ◽  
pp. 43-49 ◽  
Author(s):  
M. Szturmowicz ◽  
W. Tomkowski ◽  
A. Fijalkowska ◽  
W. Kupis ◽  
A. Cieślik ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Gold Standard ◽  
Pericardial Fluid ◽  
Optimal Cutoff ◽  
Positive Cytology ◽  
Cytological Examination ◽  
Malignant Pericardial Effusion ◽  
Negative Tumor ◽  
Cytology Result ◽  
Fluid Cytology

A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30–50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0–317) and 0.5 ng/mL (0–18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3–10080) and 22.4 ng/mL (1.87–317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.

scholarly journals Primary Cardiac Burkitt Lymphoma Presenting with Abdominal Pain

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitrios Tzachanis ◽  
Rajan Dewar ◽  
Katarina Luptakova ◽  
James D. Chang ◽  
Robin M. Joyce
Keyword(s):  
Abdominal Pain ◽  
Pericardial Effusion ◽  
Burkitt Lymphoma ◽  
Pericardial Fluid ◽  
Nuclear Chromatin ◽  
Epigastric Discomfort ◽  
Abdominal Bloating ◽  
Large Pericardial Effusion ◽  
Large Nucleolus

We describe the case of a 44-year-old woman with primary Burkitt lymphoma of the heart who presented with abdominal bloating and epigastric discomfort secondary to tamponade physiology caused by a large pericardial effusion. The pericardial fluid contained a large number of highly atypical lymphocytes with moderate basophilic cytoplasm, rare punched-out vacuoles, a vesicular nuclear chromatin, large nucleolus, and marginated chromatin that by FISH were positive for the 8;14 translocation. She had no other sites of disease. She was treated with four alternating cycles of modified CODOX-M and IVAC in combination with rituximab and remains in remission more than 5 years since diagnosis.

scholarly journals Cardiac tamponade and massive pleural effusion in a young COVID-19-positive adult

2021 ◽  
Vol 14 (9) ◽  
pp. e244518
Author(s):  
Dilip Johny ◽  
Kodangala Subramanyam ◽  
Nandakishore Baikunje ◽  
Giridhar Belur Hosmane
Keyword(s):  
Pleural Effusion ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Low Voltage ◽  
Pericardial Fluid ◽  
Rare Presentation ◽  
Large Pericardial Effusion ◽  
Left Pleural Effusion ◽  
Dimensional Echocardiography ◽  
Cardiac Manifestations

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.

scholarly journals Pericardial Tamponade And Lung Adenocarcinoma: Case Report And Literature Review

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Irene Lozano-Díez ◽  
María López-Rodríguez ◽  
Laia Cagide-González ◽  
José Antonio Díaz-Peromingo
Keyword(s):  
Pericardial Effusion ◽  
Lung Adenocarcinoma ◽  
Previous History ◽  
Pericardial Tamponade ◽  
Neoplastic Disease ◽  
Healthy Patient ◽  
Lung Cancers ◽  
Life Threatening ◽  
History Of ◽  
Recurrent Pericardial Effusion

Pericardial effusion is the accumulation of fluid between the layers of the pericardium. I massive, pericardial tamponade and compression of the myocardium are life threatening conditions. The causes of pericardial effusion are varied, from idiopathic, neoplasms, iatrogenesis, and autoimmune. Pericardial tamponade can be a complication of neoplastic disease. Malignancy must be ruled out in every cardiac tamponade. Malignant etiology must be considered in patients with previous history of malignancy, pericarditis that does not respond to anti-inflammatory treatment, pericardial effusion that increases its amount rapidly, or recurrent pericardial effusion. Metastatic pericardial effusion due to lung cancer is not rare but not all lung cancers involve the same way the pericardium. In this paper, we present the case of a previously healthy patient with pericardial tamponade as presentation form of a lung adenocarcinoma and review the literature.

Abstract 17341: A 19-Year-Old Female with Recurrent Chylopericardium

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Cheng-Han Chen ◽  
Angela Kleiber ◽  
Christine Megerdichian ◽  
Gregg C Fonarow ◽  
Arnold S Baas
Keyword(s):  
Pericardial Effusion ◽  
Thoracic Duct ◽  
Correct Diagnosis ◽  
Pericardial Fluid ◽  
Shortness Of Breath ◽  
Pericardial Window ◽  
Percutaneous Embolization ◽  
Fluid Analysis ◽  
Large Pericardial Effusion ◽  
Work Up

A 19-year-old female initially presented to an outside hospital with worsening shortness of breath over the course of hours. Echocardiogram revealed a large pericardial effusion with tamponade physiology. An urgent pericardiocentesis followed by a pericardial window yielded 600cc of cloudy fluid, and work-up for infectious, auto-immune, and malignant etiologies was unrevealing. She was discharged home, but over the next four weeks developed a repeat pericardial effusion requiring another pericardiocentesis yielding 750cc of cloudy fluid. She then presented to our hospital two weeks later with progressive shortness of breath. Echocardiogram revealed a large pericardial effusion with evidence of early tamponade physiology. Our differential diagnosis for her recurrent pericardial effusions remained broad, with infectious and malignant etiologies at the top of consideration. Computed tomography of the chest demonstrated the pericardial effusion and mild mediastinal adenopathy. She underwent another pericardial window with removal of 600cc of milky fluid, and fluid analysis was notable for a markedly elevated triglyceride level consistent with a diagnosis of chylopericardium. Work-up for malignancy as an etiology for recurrent chylopericardium was negative. A percutaneous lymphangiogram was then performed, which revealed a significant leak in the superior aspect of the thoracic duct into the pericardial space. Percutaneous embolization of the thoracic duct was performed using detachable coils along with embolic glue, resulting in resolution of the leak. She has since remained asymptomatic, and follow-up echocardiogram was without recurrence of any pericardial effusion. This case of idiopathic recurrent chylopericardium as the cause for pericardial effusion represents a rare manifestation of a relatively common cardiac condition. It illustrates the importance of routine pericardial fluid analysis for triglycerides, as this led to her correct diagnosis of chylopericardium. The use of percutaneous thoracic duct embolization has only recently been reported as a novel approach for treatment of chylous leak, and may emerge as a useful alternative to surgery for recurrent chylopericardium.

scholarly journals Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

2018 ◽  
Vol 15 (1) ◽  
pp. 35-38
Author(s):  
Smriti Shakya ◽  
Sunil Chandra Jha
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Care Center ◽  
Tertiary Care ◽  
Pericardial Fluid ◽  
Age Group ◽  
Acute Pericarditis ◽  
Old Patients ◽  
Large Pericardial Effusion ◽  
2D Echocardiography

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

scholarly journals Postoperative pericardial effusion: peculiarities of the development and course

2021 ◽  
Vol 23 (1) ◽  
pp. 131-139
Author(s):  
K. S. Kiriakov ◽  
V. M. Zakharevich ◽  
T. A. Khalilulin ◽  
N. Y. Zakharevich ◽  
N. N. Abramova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Pericardial Effusion ◽  
Heart Transplantation ◽  
Gold Standard ◽  
Standard Treatment ◽  
Life Threatening ◽  
End Stage

Heart transplantation continues to be the gold standard treatment for end-stage chronic heart failure. As with any cardiac surgery, heart transplantation is associated with postoperative complications. One of the most common complications is postoperative pericardial effusion. Heart recipients have a greater risk of developing pericardial effusion than patients after cardiac surgery on their own heart, due to surgical and immunological features. Severe pericardial effusions negatively affect the postoperative period and may be the cause of life-threatening conditions. Identification of risk factors, prevention, early diagnosis and treatment of this disease can significantly reduce the risks of adverse events in this group of patients. The purpose of this literature review is to analyze the development and course of pericardial effusion in heart recipients in world practice.

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