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

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.

Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region

ABSTRACT Background Subxiphoid pericardial window (SPW) remains a valuable diagnostic tool for patients at risk of occult cardiac injuries. However, how to select patients that could benefit from this procedure remains unclear. We aimed to identify clinical predictors of positive SPW in patients with penetrating precordial injuries. Materials and methods Prospective data collection of 183 patients who underwent SPW for the exclusion of penetrating cardiac injuries during 2002 – 2004 at a level I trauma centre in Cali, Colombia. Patient's demographics, clinical characteristics, and injury information were obtained. Independent predictors of positive SPW were assessed using stepwise logistic regressions. Results There were 41 positive SPW (22.4%). Unadjusted analyses demonstrated that stab/knife wounds (OR 2.48, 95% CI 1.17–5.25, p = 0.017), single wound (OR 14.61, 95% CI 1.9–110, p = 0.009), and clinical signs of pericardiac tamponade (OR 8.52, 95% CI 3.92–18.4, p < 0.001) were associated with increased odds of positive SPW. Conversely, systolic blood pressure (0.98, 95% CI 0.96–0.99) and stable physiological index (OR 0.31, 95% CI 0.14–0.65, p = 0.002) were associated with decreased odds. In multivariable analyses, signs of pericardiac tamponade (OR 6.37, 95% CI 2.78–14.6, p < 0.001), and single injuries (OR 12.99, 95% CI 1.6–102.7, p = 0.015) remained as independent predictors of positive SPW. Conclusion Emphasis on early recognition of the clinical signs of pericardiac tamponade could be the most important factor for the identification of occult cardiac injuries. Patients with multiple wounds to the precordial region who reached the hospital may not benefit from a SPW. However, high level of awareness is important because the incidence of occult cardiac injuries is not negligible. How to cite this article Sánchez ÁI, García AF, Velásquez M, Puyana JC. Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region. Panam J Trauma Crit Care Emerg Surg 2015;4(3):43-51.