Malignant pericardial effusion is usually treated only when signs of cardiac tamponade develop. Cytology of pericardial effusion due to malignancy in. The managementofmalignant pericardial effusions jacob j. Guidelines on the diagnosis and management of pericardial. The approach to malignant pericardial disease management is. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Malignant pericardial effusion occurs in one tenth of all cancers. Subxiphoid pericardial drainage for pericardial tamponade. We discuss management of a case of svc syndrome presenting with pericardial effusion and tamponade. Treatment of malignant pericardial effusion with 32pcolloid. Neoplastic pericardial effusion refaat 2011 clinical. A simple technique to manage malignant pericardial effusion with a local instillation of bleomycin in nonsmall cell carcinoma of the lung. Immunerelated adverse events are frequent under immunotherapies. In addition, the potential lethality of cardiac tamponade in the setting of a plasma cellbased pericardial effusion warrants further investigation of therapeutic interventions and their efficacy due to both the acute effects of tamponade and its status as a poor prognostic indicator.
Pericardial sclerosis as the primary management of. Chapter 1 cardiac complications of cancer and anticancer treatment. Thus, subsequent clinical course as well as microbiological and anatomopathological analyses may help to the differential diagnoses. Our search identified six studies describing the management of malignant pericardial effusion using extended catheter drainage table 3. The most common cause in cancer patients is a malignant effusion from lung or breast cancer lestuzzi, 2010. Examples of transthoracic echocardiograms of a large neoplastic pericardial effusion with cardiac tamponade are in figure 3. Cardiotoxic side effects, initially thought to be rare, are more often encountered paralleling the expanding use of. Frontiers pericardial effusion with tamponade in lung. Cardiac tamponade due to malignant pericardial effusion in breast cancer. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Malignant pericardial effusions palliative care network of wisconsin. In the case of initial malignant pericardial effusion, treatment with nivolumab seemed to favour recurrent pericarditis 12, 16, 18. Management of malignant pericardial effusion europe pmc.
The most common cause of pericardial effusion with tamponade is malignant disease. Pericardial effusion is a common finding in everyday practice. Cardiac tamponade cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. I believe that subxiphoid drainage remains the procedure of choice for the management of a malignant pericardial effusion with tamponade.
Epidemiology and prognosis approximately 10% of patients with cancer develop cardiac metastases, with 75% of these affecting the epicardium 1, 2. Asymptomatic pericardial effusions have been shown in about 3 % of patients at autopsy. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. In pericardial effusion, the pumping capacity of the heart is not affected, but in cardiac tamponade, there is a reduction in the pumping capacity of the heart. In these cases, the main issues are aetiology, the clinical course, and the. The aetiology is varied infectious, neoplastic, autoimmune, metabolic, and drugrelated, being tuberculosis the leading cause of pericardial effusions. Compared with controls, both bacterial and malignant pericardial fluids have higher cholesterol levels. On other occasions, pericardial effusion is an unexpected finding that requires specific evaluation. The european association for cardiothoracic surgery.
Cardiac tamponade is usually a differential diagnosis of svc syndrome. Pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space between the parietal and the visceral pericardium and is often associated with a variety of underlying disorders. Slow pericardial effusion volume pressure cardiac tamponade pericardial reserve volume limit of. There are 10 echocardiographic findings described in cardiac tamponade due to neoplastic pericardial effusion, and they are summarized here and in the table 1 18, 28. The optimal management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis with or without sclerotherapy, surgical decompression, 48 and radiation therapy 911 as primary therapeutic modalities. Pericardial effusion and cardiac tamponade symptoms and ecg.
Cardiac tamponade in 117 patients was treated with either subxiphoid pericardiostomy n 94 or percutaneous catheter drainage n 23. The groups at greatest risk of developing pericardial effusion include patients with cancer and patients with hiv and aids. Introduction malignant pericardial effusions mpes are a rare complication of advanced cancer, but are associated with high morbidity and mortality. The symptoms at presentation were panic and shortness of breath. Introduction malignant pericardial effusions mpes are a rare complication of advanced cancer, but are. A plasma cellbased pericardial effusion leading to. Download pdf version of pericardial effusion vs cardiac tamponade. Moreover, immunerelated adverse events of ici therapy are wellknown. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium. Lokich,md the accumulation of fluid in the potential space between serosal membranes may develop in 5% to 50% of patients with disseminated malignant disease.
Malignant pericardial effusions occasionally arise in patients with lung cancer. Management of malignant pericardial effusion and tamponade. Echocardiographic assessment of pericardial effusion. B survival free from malignant pericardial effusion mpe recurrence in the whole cohort and according to the treatment strategy p value is for. Does this patient with a pericardial effusion have cardiac. The presence of malignant pericardial effusion mpe is associated with. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. However, because of the small numbers of patients and the multiple therapeutic procedures carried out in this series, no significant conclusion as to the most effective therapy can be made. Cullinane ca, paz ib, smith d, carter n, grannis fw jr.
Endometrial carcinoma complicated by malignant pericardial. Several methods of treatment have been reported with an overall response rate of approximately 75%. Pericardial effusion and cardiac tamponade knowledge for. Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Epidemiology of pericardial effusion widespread pericardial effusion. Get a printable copy pdf file of the complete article 1. The aetiology is varied infectious, neoplastic, autoimmune, metabolic, and drugrelated, being. Claudius galen 1201 ad first described pericardial effusions in gladiators suffering from stab wounds to the chest and the english physician. Timely diagnosis and aggressive multimodal management improves patient outcome. Management of cardiac tamponade in patients with malignancy management of cardiac tamponade in patients with malignancy reitknecht, felice. Difference between pericardial effusion and cardiac tamponade.
This fast fact discusses the diagnosis and management of mpes. Clinical and echocardiographic features pericardial tamponade occurs when, in the presence of fluid accumulating in the pericardial. The was recurrence in one patient who had malignant effusion and was subsequently treated with pericardial window but later lost to follow up. Pericardial effusions with a cardiac tamponade constitute a surgical emergency and the pericardiocentesis represents the first class therapeutic recommendation. Surgical management of pericardial tamponade as a presenting manifestation of acute leukemia. A patient with pericardial tamponade secondary to malignant pericardial effusion underwent pericardiocentesis followed by intrapericardial instillation of recombinant interferon alfa2b intron a. Conclusion subxiphoid tube pericardiostomy still remains the main stay in the management of massive tuberculous pericardial effusion in our environment as it provides the opportunity to drain the fluid.
The patient subsequently received a full course of chemotherapy and radiation therapy for her primary malignant tumor and experienced no recurrence of the. Management of malignant pericardial effusions springerlink. As the pericardium is rather stiff, the capacity of the pericardial space is limited. Case presentation a 73yearold man being treated in the outpatient setting for a presumptive diagnosis of chronic obstructive pulmonary disease copd with shortness of breath that was not improving presented to an emergency department ed with chief. The cytologic examination of pericardial fluid obtained by pericardiocentesis confirmed metastasis. Percutaneous catheter drainage was used for patients with hemodynamic instability that precluded subxiphoid pericardiostomy. Any patient who develops symptomatic tamponade from a malignant pericardial effusion needs intervention for the effusion, preferably with. Nivolumab, a programmed death1 pd1 inhibitor, is an immune checkpoint inhibitor particularly used in the treatment of malignant melanoma, nonsmall cell lung cancer and renal cell carcinoma. Guidelines on the diagnosis and management of pericardial diseases full text the task force on the diagnosis and management of pericardial diseases of the european society of cardiology task force members, bernhard maisch. Treatment of malignant pericardial effusion with 32 pcolloid british. A 34 year old lady presented with shortness of breath and facial puffiness for.
With continuous electrocardiographic monitoring, a kifa catheter was inserted percutaneously into the pericardial sac and allowed to drain. Standardized approach to pericardial effusion management. Subxiphoid tube pericardiostomy in the management of. The pericardial effusion due to invasion of the malignant process should be differentiated from that occurring as a late sequela of irradiation of the left side of the chest. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade elizabeth a. Cardiology performed a diagnostic and therapeutic echoguided pericardiocentesis and removed 260 ml of a bloody turbid fluid. To reduce the rate of effusion recurrence following pericardiocentesis, extended catheter drainage has been attempted by placement of an indwelling catheter into the pericardial space. The most common type of pericardial involvement is represented by moderatetolarge pericardial effusions. Cardiac tamponade is a sudden life threatening condition characterized by the accumulation of pericardial fluid under pressure which decreases the movement of parietal pericardium and compresses all the chambers such that systemic venous return to the ra is compromised 35. There are numerous etiologies for pericardial effusion, including infections, malignancy, inflammation, radiation injury, trauma, drugs, myxedema, and aortic dissection table 1. Pdf management of malignant pericardial effusion researchgate.
The management of pericardial effusion in cancer patients. Variants include low pressure occult and regional cardiac tamponade. Symptom signs and laboratory tests in cardiac tamponade are shown in tables 16. Nivolumab is an immune checkpoint inhibitor ici that has shown efficacy for treating nonsmall cell lung cancer and has become a standard therapy for previously treated nonsmall cell lung cancer. Optimal management of cardiac tamponade resulting from pericardial effusion remains controversial. A drain was left in, but it removed only 10 ml of fluid overnight and was re. Intrapericardial interferon in the management of malignant. Pdf on jul 1, 2014, mary petrofsky published management of malignant. Sometimes, its cause is obviously related to an underlying general or cardiac disease, or to a syndrome of inflammatory or infectious acute pericarditis.
Clinical presentation varies, from asymptomatic pericardial effusion, constrictive disease. The management of malignant pericardial effusion remains controversial. Palliative treatment for symptomatic malignant pericardial. In addition to cisplatin instilled into the pericardial space, for systemic chemotherapy, we chose that gemcitabine and lobaplatin regimen be preferred. We present our experience with 93 patients referred for drainage and sclerosing procedures between 1979 and 1994. Once the pericardial effusion is drained it may be necessary to wean infusions of inotropes and vasopressors introduction. The aim of this paper was to summarize and critically evaluate current knowledge on the management of pericardial. Current management of symptomatic pericardial effusions in. Malignant pericardial effusions palliative care network. Malignant pericardial effusion and cardiac tamponade. The management of hemodynamic instability caused by a growing pericardial effusion and cardiac tamponade requires the prompt evacuation of the effusion. Signs of tamponade see section pericardial effusion and cardiac tamponde. Pdf cytology of pericardial effusion due to malignancy.
Tamponade, requiring a large effusion, is less common. The optimal management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis with or without. In this last category, therapy with corticosteroids has been tried successfully, while others claim that pericardiectomy is the treatment of choice, 10 x 10 lokich, jj. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. Cardiac tamponade an overview sciencedirect topics.