Pericardial Tamponade And Lung Adenocarcinoma: Case Report And Literature Review

Abstract

Pericardial effusion is the accumulation of fluid between the layers of the pericardium. I massive, pericardial tamponade and compression of the myocardium are life threatening conditions. The causes of pericardial effusion are varied, from idiopathic, neoplasms, iatrogenesis, and autoimmune. Pericardial tamponade can be a complication of neoplastic disease. Malignancy must be ruled out in every cardiac tamponade. Malignant etiology must be considered in patients with previous history of malignancy, pericarditis that does not respond to anti-inflammatory treatment, pericardial effusion that increases its amount rapidly, or recurrent pericardial effusion. Metastatic pericardial effusion due to lung cancer is not rare but not all lung cancers involve the same way the pericardium. In this paper, we present the case of a previously healthy patient with pericardial tamponade as presentation form of a lung adenocarcinoma and review the literature.

Malignant Pericardial Effusion Presenting as a Sequela of Lung Adenocarcinoma

“…Pericardial effusions clinically present with dyspnea, chest pain or chest pressure, hemodynamic lability, and/or syncope [ 9 ]. The clinical presentation of pericardial effusions in the setting of lung cancer is quite rare and is associated with poor outcomes as it is a marker of advanced disease, with 60% of the patients with malignant pericardial effusions developing cardiac tamponade [ 6 ]. Cardiac tamponade presents with worsening dyspnea, pulsus paradoxus, and Beck’s triad which entails jugular venous distension, distant heart sounds, and hypotension [ 4 ].…”

“…Lung cancer and other solid tumor-induced pericardial effusions are associated with limited survival when compared to breast cancer or hematologic malignancies [ 3 ]. Hence, it is essential to include malignancy as part of the differential diagnosis in the setting of rapidly accumulating or recurrent pericardial effusions [ 6 ].…”

“…Primary malignant pericardial effusions due to myxomas, lipomas, fibrosarcoma, lymphangiomas, hemangiomas, and neurofibromas are less common than secondary malignant pericardial effusions due to metastatic disease. Metastatic pericardial effusions can be attributed to lung adenocarcinoma or squamous cell carcinoma in up to 50% of cases, breast cancer in up to 18% of cases, and melanoma or gastrointestinal adenocarcinoma in up to 7% of patients [1,4,6]. They are frequently caused by hematogenous metastasis, lymphatic invasion, direct penetration, or intracavitary diffusion through the inferior vena cava or pulmonary veins [1,[5][6][7][8].…”

“…Metastatic pericardial effusions can be attributed to lung adenocarcinoma or squamous cell carcinoma in up to 50% of cases, breast cancer in up to 18% of cases, and melanoma or gastrointestinal adenocarcinoma in up to 7% of patients [1,4,6]. They are frequently caused by hematogenous metastasis, lymphatic invasion, direct penetration, or intracavitary diffusion through the inferior vena cava or pulmonary veins [1,[5][6][7][8].…”