Secondary Malignant Tumors of the Pericardium

Abstract

Among 13,314 necropsies following death from neoplastic and nonneoplastic diseases performed at the Mayo Clinic from 1942 through 1958, 189 cases of secondary malignant lesions of the pericardium were demonstrated, an incidence of 1.42 per cent. Carcinoma of the lung and breast, the lymphomas, and leukemia constituted the large majority of the primary malignant lesions that caused the pericardial metastasis. Fifty-five of the 189 patients were adjudged to have had some impairment of cardiac function as a consequence of the pericardial metastasis and the following conclusions concern this group. 1. In 47 patients (86 per cent), the lesions were either the immediate or a contributory cause of death. 2. The most common mechanism whereby metastatic lesions in the pericardium interfered with cardiac function was by the development of pericardial effusion. Next in frequency was effusion combined with myocardial invasion and then cardiac constriction by tumor. Combinations of these processes with malignant encroachment on the great vessels and with invasion of coronary veins were the other mechanisms noted. Involvement of coronary arteries and the cardiac nerve supply was not noted. 3. Pericardial fluid was significant in causing tamponade in 31 cases. The fluid was frankly hemorrhagic in a small minority of these cases although fibrinous pericarditis was present in 45 (82 per cent) of the group. Pleural effusion was present in 48 (92 per cent) of 52 cases and was usually bilateral. Ascites was present in 22 (50 per cent) of 44 cases; the quantity was usually rather small. 4. Only one patient had metastasis to the pericardium without metastasis to other thoracic structures; exclusive of patients with leukemia, 43 (92 per cent) of 47 patients had extrathoracic metastatic lesions. 5. Dyspnea, cough, pleural effusion, hepatomegaly, and thoracic pain were the most commonly recorded signs and symptoms that might be related to the pericardial lesions. However, more specific signs and symptoms directing attention to pericardial or cardiac involvement were not commonly recorded. 6. The diagnosis of pericardial metastatic disease was suspected or established in only 16 (29 per cent) of the 55 patients, although 34 (62 per cent) either received treatment for congestive heart failure or were given roentgen therapy to mediastinal structures. 7. Of the 27 patients whose electrocardiograms were available, 25 had T-wave abnormalities, 22 had low QRS voltage, and 15 showed sinus tachycardia. 8. Thoracic roentgenograms, made on 53 patients, supplied clues to the diagnosis of pericardial malignancy in 28.

Pericardiocentesis versus Pericardiotomy for Malignant Pericardial Effusion: A Retrospective Comparison

“…Patients are often asymptomatic, but they can also present with cardiorespiratory symptoms (for example, dyspnea, cough, chest pain), clinical signs (tachycardia, for instance), echocardiographic features of right heart compromise, and possibly life-threatening cardiac tamponade requiring emergency drainage 2 . Malignancies can involve the pericardium by four mechanisms: direct extension or metastatic spread via lymphatics or blood, chemotherapeutic toxicity, radiation toxicity, and opportunistic infections related to immunosuppressive therapies 3 .…”

Incidence of Malignancy Related Pericardial Effusion in a Tertiary Hospital

“…Furthermore, in a review of 55 patients with cancer who had pericardial disease, Thurber and co-workers found that pericardial involvement resulted in or contributed significantly to the cause of death in 85% of patients. 11 Thus, therapeutic interventions directed at controlling this complication of malignancy can, if successful, result in prolonging survival. The overall survival and quality of life of patients with malignant pericardial effusion is dictated primarily by the histological type and extent of the underlying malignant process.…”

Atrial Metastatic Tumor: Transthoracic and Transesophageal Echocardiograph Imaging

“…tributable to pericardial effusion [11]. In literature a highly variable incidence of cardiac metastases is reported, ranging from 2.3% and 18.3% [8,12].…”