A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder

A 62-year-old man presented with 2 weeks of progressive dyspnea and chest pain. He was previously diagnosed with high-grade invasive urothelial carcinoma (UC) of the bladder and underwent neoadjuvant chemotherapy followed by radical cystectomy 10 months earlier, resulting in pathologic complete remission. Clinical evaluation and echocardiographic imaging was consistent with a diagnosis of cardiac tamponade. Due to a history of malignancy, the patient was referred for a surgical pericardial window, to include biopsy of the pericardium. Pericardial fluid and pericardial biopsy specimens were consistent with metastatic UC. Cardiac tamponade due to metastatic UC is a rare presentation, and, to our knowledge, there have been only 5 cases reported in the English literature. We report a rare case of cardiac tamponade due to isolated pericardial metastases from high grade UC of the bladder and discuss the symptoms, treatment, and prognosis of this pathologic condition. We also present a brief review of previously published literature. Through this discussion, we would like to emphasize the (1) consideration of cardiac metastases in the differential diagnosis for patients with a history of UC presenting with cardiac or pulmonary symptoms and (2) improved diagnostics with pericardial biopsy and pericardiocentesis over pericardiocentesis alone.

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Cardiac tamponade due to malignant pericardial effusion in breast cancer: A case report

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v9i1.28946 ◽

2016 ◽

Vol 9 (1) ◽

pp. 53

Author(s):

Sultan Mahmud ◽

Omar Sadeque Khan ◽

Md. Aftabuddin ◽

Asit Baran Adhikary

Keyword(s):

Breast Cancer ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Duct Cell ◽

Pericardial Fluid ◽

Pericardial Window ◽

Severe Respiratory Distress ◽

Malignant Pericardial Effusion ◽

History Of ◽

Subxiphoid Pericardial Window

We present a case of 35 years old women who presented to our institution with a history of bilateral infiltrating duct cell carcinoma of breast, chest pain with heaviness, severe respiratory distress and hypotension. Echocardiography revealed massive pericardial effusion with features of cardiac tamponade. The patient was treated with urgent pericardiocentesis followed by subxiphoid pericardial window drainage of 500ml of haemorrhagic pericardial fluid. Cytological examination confirmed the previous suspicious of malignancy. The patient tolerated the procedure very well, immediate symptomatic relief was observed.

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Pericardial Metastasis Induced Tamponade from Urothelial Carcinoma: A Rare Entity

Case Reports in Medicine ◽

10.1155/2016/6162732 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Rafay Khan ◽

Waqas Jehangir ◽

Sunil Tulpule ◽

Mohamed Osman ◽

Shilpi Singh ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Cardiac Tamponade ◽

Cardiac Metastasis ◽

Rare Entity ◽

Rare Presentation ◽

Cardiac Symptoms ◽

History Of ◽

Pericardial Metastasis ◽

Onset Atrial Fibrillation ◽

New Onset

Urothelial carcinoma in a few cases may result in cardiac metastasis. A rare presentation of this condition is its diagnosis as a result of cardiac tamponade. Tamponade is an unusual entity as a result of urothelial carcinoma and has only been reported in four cases. There have also been only a total of fifteen cases of cardiac metastasis from this form of malignancy. It is through this discussion that we emphasize the importance of early detection and monitoring of cardiac symptoms with the implementation of echocardiogram imaging. Although not feasible in all patients it may be considered in those presenting with cardiac and pulmonary symptoms. In this case we discuss the presentation of a 71-year-old gentleman with a history of urothelial carcinoma after cystectomy and while on chemotherapy presented with new onset atrial fibrillation and later was diagnosed with cardiac tamponade as a result of malignant metastasis.

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Vulvar Paget disease secondary to high-grade urothelial carcinoma with underlying massive vascular embolization and cervical involvement: case report of unusual presentation

Diagnostic Pathology ◽

10.1186/s13000-019-0895-0 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Walquiria Quida Salles Pereira Primo ◽

Guttenberg Rodrigues Pereira Primo ◽

Dunya Bachour Basilio ◽

Karime Kalil Machado ◽

Jesus Paula Carvalho ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Immunohistochemical Analysis ◽

Low Grade ◽

High Grade ◽

Paget Disease ◽

Careful Clinical Examination ◽

History Of ◽

Carcinoma Of The Bladder ◽

Tumor Emboli ◽

Specific Symptoms

Abstract Background Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management. Case presentation We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms. Conclusions Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.

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Corrigendum to “A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder”

Case Reports in Cardiology ◽

10.1155/2019/8376360 ◽

2019 ◽

Vol 2019 ◽

pp. 1-1

Author(s):

Sowmya Palam ◽

Ridhima Kapoor ◽

Amrou Abdelkader ◽

Jacquelyn Kulinski

Keyword(s):

Urothelial Carcinoma ◽

Cardiac Tamponade ◽

Rare Presentation ◽

Metastatic Urothelial Carcinoma ◽

Carcinoma Of The Bladder

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The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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Incidentally Discovered Osseous Metaplasia Within High-grade Urothelial Carcinoma of the Bladder

Urology ◽

10.1016/j.urology.2011.06.043 ◽

2012 ◽

Vol 79 (4) ◽

pp. e59-e60 ◽

Cited By ~ 3

Author(s):

Anne G. Dudley ◽

Jeffrey J. Tomaszewski ◽

Amber H. Hughes ◽

Benjamin J. Davies

Keyword(s):

Urothelial Carcinoma ◽

Osseous Metaplasia ◽

High Grade ◽

Carcinoma Of The Bladder

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Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02467-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Christina Walker ◽

Vincent Peyko ◽

Charles Farrell ◽

Jeanine Awad-Spirtos ◽

Matthew Adamo ◽

...

Keyword(s):

Case Report ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Case Reports ◽

Healthy Woman ◽

Signs And Symptoms ◽

Rare Presentation ◽

Pericardial Window ◽

Acute Pericarditis ◽

Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

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