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

Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review

Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival outcomes of patients with breast cancer who developed cardiac tamponade. Three databases (PubMed, EMBASE and SCOPUS) were searched for relevant articles published from 1978 to 2022 and 16 articles were identified comprising 64 cases. The median age of the cases was 52 years. Cardiac tamponade was diagnosed with echocardiogram or computerized tomography of the chest or both in 91.9%, 1.6% and 6.5% of the cases, respectively. Cytology of the pericardial fluid was done in 90.5% of the cases while biopsy in addition to cytology was done in 9.5% of cases. Tamponade was proven to be malignant in 97.4% of the cases. The initial treatment for tamponade was pericardiocentesis. Adjunct therapies ranged from the insertion of a pericardial window, pericardiectomy, radiotherapy and chemotherapy. The median time from the first treatment of breast cancer to the onset of tamponade was 24 months while the median survival following diagnosis of tamponade was 13 months. There was no significant correlation (spearman rank-sum correlation coefficient= 0.35, p = 0.165) between time to tamponade (interval time from the first diagnosis of breast cancer and the onset of cardiac tamponade) and survival. Cardiac tamponade may adversely affect survival in patients with breast cancer. Early diagnosis with echocardiogram and cytology may guide management and expectations. Further observational studies are needed to determine the predictors of cardiac tamponade and optimal treatment in patients with breast cancer.

Renal carcinoma presenting as cardiac tamponade: a case report and review of literature

Pericardial involvement in an advanced malignancy is common but malignancy presenting as cardiac tamponade is rather uncommon. Review of English literature using Medline CD ROM revealed 131 cases since 1935, who have presented with this life threatening emergency. Lung is the most common primary site followed by lymphomas and leukemias. We report a case of transitional cell carcinoma of kidney presenting as cardiac tamponade. Such a presentation of transitional cell carcinoma of kidney has never been reported.

Case report: malignant pericardial effusion as the initial manifestation of malignancy

Although malignant pericardial effusion is a common complication of malignancy, it is rarely the initial manifestation. A case of a nonsmoking 36-year-old woman who had pericardial tamponade due to malignant pericardial effusion as the initial manifestation of malignancy is presented. Case reports of patients with malignant pericardial effusion as the initial manifestation of malignancy published since 1974 are reviewed. The clinical presentation, histology, and survival of these patients is compared with those cases published prior to 1974. Survival of patients with primary malignancy in the lung who present with malignant pericardial effusion has not improved.

Cardiac tamponade as the initial presentation of malignancy

We describe a series of five patients who had cardiac tamponade at the time of initial presentation as a result of extracardiac malignancy. Three cases had adenocarcinoma and two had squamous cell carcinoma. The diagnosis of bronchogenic carcinoma was established after appropriate investigations in three cases. One patient possibly had a primary malignancy of the gastro-intestinal tract. The relevant literature is reviewed.

Medical management of malignant pericardial effusion by tetracycline sclerosis

Fifty-eight patients with malignant pericardial effusion were seen from 1979 to 1986. A Kifa catheter was inserted into the pericardial sac and allowed to drain for 12 to 24 hours during electrocardiographic monitoring. Lidocaine hydrochloride, 100 mg, was instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, in 20 ml of normal saline solution. The catheter was clamped for 1 to 2 hours and then reopened. This procedure was repeated daily until the net drainage was less than 25 ml/24 hours. There were 22 male and 36 female patients (median age 58 years). The primary malignancy included lung (27 patients), breast (16 patients), stomach (3 patients), adenocarcinoma of unknown primary (7 patients), mesothelioma (2 patients) and chronic granulocytic leukemia, ovary and lymphoma (1 patient each). Fifty-six patients received 1 to 5 tetracycline instillations. In 1 patient, the catheter could not be inserted and in another, clotting occurred within the catheter before injection of tetracycline. Complications included transient atrial arrhythmias (5 patients), pain after injection (9 patients) and temperature higher than 37.5 degrees C (5 patients). One patient had a cardiac arrest during pericardiocentesis. Forty-three patients (74%) had control of their effusions for longer than 30 days (median survival 168 days, range 30 to 1,149+), and 5 patients (9%) died before 30 days without effusion. Eight patients (14%) did not achieve control. One declined further therapy after 1 instillation, and 3 died within 6 days with progressive malignancy. One patient had persistent drainage after 3 instillations, and 3 had reaccumulation of fluid 2, 6 and 27 days after catheter removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Pericardial effusion in women with breast cancer

Ninety patients with a history of breast cancer and pericardial effusion detected on echocardiography were identified and divided on a clinical basis into three groups. Group 1 consisted of 20 patients who had progressive metastatic breast cancer and echocardiography performed on a routine basis as a part of a clinical trial involving 38 patients. All 20 had small unexpected effusions, and only one patient developed symptomatic malignant pericardial disease late in her clinical course. Group 2 consisted of 32 patients who were without evidence of metastatic disease at the time of positive echocardiography and the etiology was considered benign in all patients. Six patients required pericardiectomy, five for severe radiation induced pericarditis and one for amyloid. No patient developed proven or suspected malignant pericardial disease. Group 3 comprised 38 patients who had known metastatic disease outside the pericardium at the time of positive echocardiography. Nineteen patients in Group 3 had histologically proven malignant involvement during life or at autopsy, and five more had suspected malignant pericardial disease. Ten patients initially were treated with pericardiectomy and 28 patients were managed with systemic therapy alone (24 patients) or with pericardiocentesis (four patients). Among the 12 patients with malignant effusion treated without surgery, proven local progression of pericardial disease occurred in six, with sudden death in two of those patients. No patient treated initially with surgery suffered progression of her pericardial disease. It was concluded that: small, clinically unsuspected pericardial effusions appear to be relatively common in women with metastatic breast cancer; no patient with clinical pericardial disease confirmed on echocardiography and no evidence of metastatic breast cancer developed malignant pericardial involvement; 50% of patients with known metastatic disease and a clinically apparent pericardial effusion had malignant pericardial disease; and nonsurgical therapy in patients with histologically proven or clinically suspected malignant pericardial effusion was associated with a high incidence of progressive pericardial disease.

Cardiac tamponade as the only initial feature of malignancy: a case report and review of the literature

Cardiac involvement in the form of pericardial effusion or tamponade as the initial feature of extracardiac malignancy is extremely rare. An extensive search of medical literature yielded only 36 such cases. A case is presented and literature reviewed.

Cardiac tamponade in lung cancer

Neoplastic cardiac tamponade is extraordinary and dramatic as an initial presentation of cancer and not so unusual as a late complication. Five clinically and microscopically confirmed cases of cardiac tamponade as the first manifestation of pulmonary adenocarcinoma are reported along with a review of pertinent literature.

Non-Hodgkin's lymphoma presenting as malignant pericardial effusion and cardiac tamponade

A case of malignant lymphoma, Rappaport histiocytic type, in which the initial clinical presentation was malignant pericardial effusion with cardiac tamponade is presented. The pathogenesis of malignant pericardial effusion is discussed, and the value of cytology in the diagnosis of malignant pericardial effusion is emphasized.

Extracardiac malignancy presenting with cardiac tamponade

The clinicopathologic features of a case of cardiac tamponade as the initial presentation of extracardiac malignancy is reported and compared with those of previously reported cases. The lung was the site of the primary tumor in 58% of the cases. Irrespective of the sites of the primary tumor, mediastinal involvement or intrapulmonary metastases or both were documented in 88% of the cases. Examinations of the pericardial fluid and pericardiectomy specimen were negative in a considerable number of cases. Therefore, careful examination of the mediastinum and the accessible lung tissue at the time of pericardiectomy may reveal the malignant nature of the disease which may otherwise remain undiagnosed.