Cardiac tamponade – unusual clinical manifestation of undiagnosed malignant neoplasm

Abstract

Cardiac tamponade may be the first or predominant symptom of some pathologies but its etiology is not uncommonly unknown on admission to hospital. The purpose of this study was to evaluate the predominant causes of cardiac tamponade in previously healthy patients treated emergently in a single cardiac surgical center. The study involved 81 patients with the mean age of 58.1±16.0 years who underwent emergent subxyphoid pericardiotomy due to cardiac tamponade. Pericardial effusion was analyzed macro- and microscopically. Examinations done in the cardiac surgical department revealed pericarditis secondary to infection (n=17) or autoimmunologic processes (n=2) and malignancy in 18 patients (predominantly of the lungs (n=11)). Pericardial effusion obtained from patients with viral and autoimmunologic-induced pericarditis was straw-color and odorless while with bacterial infections dark yellow, iridescent and usually malodorous. Additional workup in the regional hospitals enabled to reveal malignant tumors in 29 patients, leukemia or lymphoma in 5 subjects. In all but one of the neoplastic cases, pericardial fluid was turbid and dark red or plummy. In 10 patients etiology of tamponade remained unknown. In conclusion, cardiac tamponade in previously healthy patients may be occasionally the predominant symptom of cancer, especially of the lungs. Macroscopic intraoperative appearance of pericardial fluid may be helpful in identification of causative condition of cardiac tamponade.

Two Cases of Laparoscopic Resection of Siewert Type II Adenocarcinoma of the Esophagogastric Junction Using a Transhiatal Approach and Complicated by Hemopericardium

“…Other causes of postoperative hemopericardium are as follows. First, the most common malignancies with cardiac metastases include melanoma and primary mediastinal malignancies [ 12 ], which did not include the tumors in our cases. Additionally, metastatic tumors of the heart must involve the pericardium to give rise to hemopericardium.…”

Acute Myeloid Leukemia Presenting as Effusive Constrictive Pericarditis

“…Only eight of those 47 patients had positive pericardial fluid cytology. 7 Kim et al 8 studied 98 patients with known active malignancy who underwent pericardiocentesis for tamponade or imminent tamponade and reported that 75 of 98 samples (77%) had positive cytology. All 23 negative samples were exudative, and there were no alternative explanations for the effusions, so they were considered malignant.…”

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

“…Some studies have suggested that as many as 20% of pericardial effusions without an obvious cause after routine evaluation constitute the initial manifestation of a cancer [2]. Indeed, Perek B et al concluded in their study of 81 previously healthy patients, which cardiac tamponade was the main symptom of cancer, especially of the lungs [3].…”