Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer

Abstract

Carcinomatous pericarditis is a rare complication of locally aggressive breast cancer in which malignant cells directly extend into the pericardium causing inflammation and creating a pericardial effusion. A 40year-old woman with untreated metastatic breast cancer presented to an outpatient clinic in significant distress with symptoms of progressive shortness of breath and bilateral leg swelling. An urgent echocardiogram demonstrated a large pericardial effusion with echocardiographic evidence of cardiac tamponade. She underwent emergent pericardiocentesis of the effusion that was deemed to be malignant after cytologic evaluation. Subsequently, she opted for palliative treatment involving the surgical creation of a right pericardial window and placement of an indwelling pleural catheter. Internists should maintain a high index of suspicion for malignant cardiac tamponade in at-risk patients, especially those with locally aggressive and advanced malignancies.

Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review

“…The initial treatment of cardiac tamponade was pericardiocentesis in all the included studies in our review [1][2][3][4][7][8][9][10][11][12][13][14][15][16][17][18]; in some cases, this was enough to treat the tamponade. However, others received adjunct therapies such as surgery (pericardial window or pericardiectomy) or chemotherapy (local intra-pericardial instillation or systemic).…”

“…Pathology of cardiac tamponade was reported in 42 cases [1,2,[7][8][9][10][11][12][13][14][15][16][17][18]. Cytology of the pericardial fluid was conducted in 90.5% (n=38), and biopsy in addition to cytology was done in 9.5% (n=4) of the cases (Table 3).…”

“…The pericardial fluid was malignant in 97.4% (n=42) of the cases and benign in one patient. From the studies that reported the time to tamponade [2,3,7,8,[10][11][12][13][14][15][16]18], the median time to the occurrences of cardiac tamponade after the first cancer treatment was 26 months (0-156). There was no evidence of metastases to other extra-pericardial secondary sites in three of the included studies [11,13,15].…”

“…All cases were females. The proportion of patients with left breast cancer based on 13 cases reported [ 7 , 8 , 10 - 18 ] was 76.9% (n=10). The histology of breast cancer was reported in 9 studies [ 3 , 7 - 10 , 13 , 14 , 16 , 18 ], and the majority were invasive ductal carcinoma 90.9% (n=10).…”

“…Metastasis of breast cancer to other secondary sites apart from the pericardium was reported in 11 studies[1][2][3][4]7,8,10,12,14,16,18]. The common sites were lungs, bone, peritoneum, lymph nodes, brain, and liver.…”