A Case of Stage II Ascending Colon Cancer with Cardiac Tamponade Due to Pericardial Metastasis

Cardiac tamponade

Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.

Malignant Pericardial Effusion due to Colorectal Cancer in a Young Man

A 28-year-old man presented with sudden-onset right lower quadrant abdominal pain and shortness of breath at rest. On examination, he had tachycardia with distant heart sounds and right lower quadrant tenderness. A computed tomography scan showed segmental thickening of the proximal ascending colon and ileum with proximal cecal distension. Echocardiogram confirmed large pericardial effusion with impending tamponade. Video-assisted thoracoscopic surgery was performed for pericardial fluid drainage from a pericardial window. The mediastinal lymph node biopsy revealed metastatic adenocarcinoma cells. A colonoscopy showed a large polypoidal mass in the ascending colon with biopsy confirming poorly differentiated adenocarcinoma, thereby suggesting a possible lymphatic or hematogenous spread without liver or lung involvement.

Solitary anterior mediastinal lymph node metastasis with pericardial invasion from colon cancer: A case report

Colorectal cancer commonly metastasizes to the regional lymph nodes, liver, lungs and peritoneum. At present, mediastinal lymph node metastasis from colorectal cancer is uncommon and poorly understood. The present study reported a case of solitary anterior mediastinal lymph node metastasis with pericardial invasion from transverse colon cancer. An 82-year-old woman had a history of colectomy with regional lymph node dissection for transverse colon cancer (T1N1bM0 stage IIIA in the UICC classification). The patient had no symptoms, but follow-up contrast-enhanced computed tomography revealed an anterior mediastinal tumor compressing the heart 18 months after colectomy. The tumor showed fluorodeoxyglucose uptake on positron emission tomography. Resection of the anterior mediastinal tumor with pericardiectomy was performed. The tumor was 35x25 mm in size and was histopathologically characterized to be adenocarcinoma. These cells expressed cytokeratin (CK)20 and caudal-type homeobox protein 2 but not CK7 and thyroid transcription factor 1 on immunohistochemical analysis, confirming a diagnosis of metachronous mediastinal metastasis originating from colon cancer. The tumor cells invaded the adjacent pericardium and diaphragm pathologically. The patient has lived without recurrence 8 months after the surgery for mediastinal metastasis. In conclusion, clinicians should consider metastasis to the mediastinum during follow-up in patients with colorectal cancer. Surgery may be the most reliable treatment for solitary anterior mediastinal lymph node metastasis, preventing carcinomatous pericarditis through direct pericardial invasion.

Malignant pericardial effusion as a primary manifestation of metastatic colon cancer: a case report

Background

Pericardial neoplastic involvement is rarely related to primary tumors of the pericardium and is most often caused by spread from other primary sites, such as lung and breast carcinomas, hematological malignancies (lymphoma and leukemia), and melanoma. Although pericardial metastasis from infradiaphragmatic tumors (such as colon cancers) are rare and poorly described in literature, any neoplasm has the potential to metastasize to the pericardium and heart by either contiguity, lymphatic, or hematological spread.

Case presentation

A 44-year-old previously healthy male Causasian patient had a sudden onset of dyspnea and wheezing. During investigation with echocardiogram, computed tomography and repeated pericardiocentesis, the cause of malignant pericardial effusion was confirmed as primary manifestation of metastatic colon cancer. The patient was treated with appropriate chemotherapy and presented satisfactory disease control.

Conclusions

This report emphasizes the importance of considering the diagnostic hypothesis of occult neoplasia in a patient with pericardial effusion.