Prognosis and role of clinical and imaging features in patients with malignant pericardial effusion: a single-center study in China

Abstract Background The diagnosis of malignant pericardial effusion (MPE) is often associated with a poor prognosis, but due to the complexity and unspecific nature of MPE patients' clinical manifestations, imaging often performs an essential role in diagnosis and prognosis. Methods Patients diagnosed with MPE between 2013 and 2018 at one tumor hospital were included and followed up. The data covered the basic clinical features, imaging findings, treatments and prognosis of patients with MPE, and the factors that may have affected the prognosis were explored. Results A total of 216 patients with MPE were included with the median age of 60 years. The most common primary cancer type was lung cancer (73.6%), the most common symptom was dyspnea (62.9%) and the most common abnormal electrocardiogram finding was sinus tachycardia (42.1%). The median survival time of the 216 patients with MPE was 13.7 months. The factors affecting prognosis were echocardiographic fluid signs (HR = 2.37, P = 0.010), electrocardiographic evidence of sinus tachycardia (HR = 1.76, P = 0.006) and echocardiographic evidence of cardiac tamponade (HR = 3.33, P < 0.001). Conclusions MPE has complex clinical manifestations and an unsatisfactory prognosis. Echocardiographic fluid signs, electrocardiographic evidence of sinus tachycardia, and echocardiographic evidence of cardiac tamponade are independent risk factors affecting prognosis.

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Malignant pericardial effusion complicated by cardiac tamponade under atezolizumab

SAGE Open Medical Case Reports ◽

10.1177/2050313x211036005 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110360

Author(s):

Lardinois Benjamin ◽

Goeminne Jean-Charles ◽

Miller Laurence ◽

Randazzo Adrien ◽

Laurent Terry ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Cardiac Toxicity ◽

Checkpoint Inhibitors ◽

Final Diagnosis ◽

Pericardial Fluid ◽

Malignant Pericardial Effusion ◽

Typical Cell ◽

High Fluorescence ◽

Tomography Scan

Immune-related adverse events including cardiac toxicity are increasingly described in patients receiving immune checkpoint inhibitors. We described a malignant pericardial effusion complicated by a cardiac tamponade in an advanced non-small cell lung cancer patient who had received five infusions of atezolizumab, a PDL-1 monoclonal antibody, in combination with cabozantinib. The definitive diagnosis was quickly made by cytology examination showing typical cell abnormalities and high fluorescence cell information provided by the hematology analyzer. The administration of atezolizumab and cabozantinib was temporarily discontinued due to cardiogenic hepatic failure following cardiac tamponade. After the re-initiation of the treatment, pericardial effusion relapsed. In this patient, the analysis of the pericardial fluid led to the final diagnosis of pericardial tumor progression. This was afterwards confirmed by the finding of proliferating intrapericardial tissue by computed tomography scan and ultrasound. This report emphasizes the value of cytology analysis performed in a hematology laboratory as an accurate and immediate tool for malignancy detection in pericardial effusions.

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Unsuspected Malignant Pericardial Effusion Causing Cardiac Tamponade

CHEST Journal ◽

10.1378/chest.82.4.501 ◽

1982 ◽

Vol 82 (4) ◽

pp. 501-503 ◽

Cited By ~ 13

Author(s):

Frank E. Johnson ◽

Michael K. Wolverson ◽

Murali Sundaram ◽

Elisabeth Heiberg

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Malignant Pericardial Effusion

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Survival After Malignant Pericardial Effusion and Cardiac Tamponade in Advanced Ovarian Cancer

Southern Medical Journal ◽

10.1097/00007611-199002000-00028 ◽

1990 ◽

Vol 83 (2) ◽

pp. 241-242 ◽

Cited By ~ 9

Author(s):

ZOHAR LEVITAN ◽

ALAN L. KAPLAN ◽

ALAN N. GORDON

Keyword(s):

Ovarian Cancer ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Advanced Ovarian Cancer ◽

Malignant Pericardial Effusion

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Graves’ disease inducing a massive cardiac tamponade

BMJ Case Reports ◽

10.1136/bcr-2020-239772 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239772

Author(s):

Elisabeth Martinez Fonseca ◽

Igor Schonhofen ◽

Maria Pereira Toralles ◽

Jozelio Freire de Carvalho

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Nyha Class ◽

Clinical Manifestations ◽

Emergency Admission ◽

Heart Association ◽

Pericardial Fluid ◽

Graves Disease ◽

Class Iii ◽

Filling Time

A 23-year-old woman was diagnosed with Graves’ disease 5 months ago with decompensated thyroid function, for which she is taking thiamazole and propranolol. She developed progressive respiratory dyspnoea [New York Heart Association (NYHA) class III] and frequent palpitations. On emergency admission, the patient was tachypnoeic, hypotensive (77/54 mm Hg) and tachycardic (120 beats per minute), with an oxygen saturation of 94%. She also presented with cold, swollen and shaky extremities, with extended capillary filling time, and a significant reduction in heart sounds. Echocardiogram showed massive pericardial effusion compatible with cardiac tamponade. Pericardiocentesis was performed, with a drainage of 1420 mL serosanguinolent fluid, with prompt haemodynamic recovery. Analysis of the pericardial fluid showed exudates. A diagnosis of pericardial effusion secondary to Graves’ disease was determined and corticotherapy, lithium carbonate, cholestyramine and phenobarbital were prescribed. An oral iodine-131 was performed and the patient showed reasonable control of the clinical manifestations of hyperthyroidism. After 3 months, the patient showed no symptoms of hyperthyroidism and a new echocardiogram revealed a significant reduction in pericardial effusion.

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Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m165 ◽

2021 ◽

Author(s):

Oktay Şenöz ◽

Volkan Emren ◽

Zeynep Yapan Emren ◽

Ahmet Erseçgin ◽

Ferhat Siyamend Yurdam ◽

...

Keyword(s):

Pericardial Effusion ◽

Hospital Mortality ◽

Antithrombotic Therapy ◽

Pericardial Fluid ◽

Common Symptom ◽

Important Indicator ◽

Factors Affecting ◽

Cardiac Compression ◽

Asymptomatic Patients ◽

Common Causes

Objectives: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3±15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p=0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR = 3.447; 95% CI = 1.266, 9.386; p = 0.015), and receiving antithrombotic therapy (OR = 2.306; 95% CI = 1.078, 4.932; p=0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality.

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502 Secondary cardiac lymphoma complicated with tamponade

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.266 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

P H Lee

Keyword(s):

Pericardial Effusion ◽

Malignant Lymphoma ◽

Cardiac Tamponade ◽

Complete Resolution ◽

Sinus Tachycardia ◽

Left Ventricular ◽

Pulmonary Congestion ◽

Shortness Of Breath ◽

Pericardial Mass

Abstract Introduction A 72-year-old lady presented with one-week history of palpitation and shortness of breath. She had pyrexia of unknown origin for 4 weeks associated with weight loss. Initial clinical examination revealed sinus tachycardia of 110 beats/min and saturations of 96% on 2L/min oxygen. Neck exam revealed a 2 x 3 cm firm mass at left supraclavicular fossa. Electrocardiogram showed sinus tachycardia at 106 beats/min. There was fixed T wave inversions over anterolateral chest leads and inferior limb leads. Chest radiograph showed enlarged cardiac silhouette and evidence of pulmonary congestion Procedure Transthoracic echocardiogram revealed a moderate pericardial effusion with an 8 x 4 cm pericardial mass compressing at the right atrioventricular groove (Figure B & C). Respiratory variation of Doppler mitral and tricuspid inflow velocities suggested cardiac tamponade (Figure A). Inferior vena cava was engorged with impaired inspiratory collapse. Left ventricular size and function were otherwise normal. Urgent pericardiocentesis was performed which yielded 1 litre of light blood stained fluid. Her had subjective improvement of symptoms. There was also resolution of sinus tachycardia and pulmonary congestion. PET/CT scan showed multiple enlarged hypermetabolic lymph nodes in multiple regions above and below the diaphragm, worrisome for malignant lymphoma. Cytological assessment of pericardial fluid showed scattered large lymphoid cells which are immunoreactive to B cell marker CD 20 (Figure E & F). Bone marrow exam showed normal marrow. First cycle of R-CEOP and intrathecal methotrexate was given. Follow-up echocardiogram in one week after chemotherapy showed complete resolution of pericardial effusion. Prior pericardial mass also showed marked reduction in size (Figure D). No tamponade physiology was present. She tolerated the chemotherapy well with complete resolution of palpitation and shortness of breath. She was discharged from hospital with outpatient follow up and continuation of chemotherapy course. Discussion Cardiac tumors are rare and secondary tumors remain the most common etiology. Most of these metastatic tumors arise from solid organs such as lung, breast, kidney, melanoma as well as lymphoma. Echocardiography is a valuable tool both in diagnosis and assessment of hemodynamic significance of cardiac masses. It also aids in diagnosis of associated condition such as pericardial effusion. In this case, the cardiac tamponade is both contributed by mechanical compression of cardiac mass coupled with moderate pericardial effusion. Successful pericardiocentesis achieved temporary normalization of tamponade physiology and aided in early histological diagnosis of malignant lymphoma with pericardial metastasis. Timely initiation of intensive systemic chemotherapy was the key to rapid tumor size reduction, complete resolution of tamponade physiology and control of recurrent pericardial effusion. Abstract 502 Figure. Echo & histology

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