Pdf treatment of neoplastic pericardial effusion in lung. Malignant pericardial effusions deepak singh mark r. Katlic malignant pericardial effusion is often a clinically challenging entity. Table 1 causes of pleuropericardial effusion investigations should be directed at determining the cause and will initially involve haematological tests. The presence of a pericardial effusion most often indicates one of two things. Chest xray cxr the chest xray is rarely informative in acute pericarditis. Cardiacmagneticresonance cmris the imaging modalityof choicefor cardiactumors inpeople. Neoplastic pericardial effusion npe occurs in about 10% of cancer patients and is related to poor prognosis with median survival not exceeding 5 months. As mentioned above, pericardial effusion in patients is not always due to malignancy. Neoplastic pericardial effusion request pdf researchgate. Both the pleural and pericardial effusion were modified transudates and contained reactive mesothelial cells. Classic electro cardiographic changes include widespread concave upward stsegment elevation without reciprocal twave inversions.
Introduction malignant pericardial effusions mpes are a rare complication of advanced cancer, but are associated with high morbidity and mortality. Cardiac magnetic resonance in the differentiation of. Jul 11, 2019 at present, there is no accurate and effective method for treating neoplastic pericardial effusion. Pericardial disease is a malignancy complication found in 1.
In these cases, the main issues are aetiology, the clinical course, and the. Neoplastic pericardial effusion is a common and serious manifestation of advanced malignancies. The buildup of fluid may affect how the heart works. Pericardial involvement in neoplasia may arise from several different pathophysiological mechanisms and may be manifested by pericardial effusion with or. A 15yearold domestic shorthair cat was presented with a fiveday history of progressive inappetence, lethargy and dyspnoea. Cytology of pericardial effusion due to malignancy in. Neoplastic cardiac tamponade nct is a lifethreatening complication of cancer. It may develop from direct extension or metastatic spread of the underlying malignancy, from an opportunistic infection, or from a complication of radiation therapy or chemotherapeutic toxicity. The therapeutic possibilities include extended indwelling pericardial catheter, percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents. Generally, pericardial neoplastic involvement is metastatic and occurs after the diagnosis of the primary neoplasia.
Pericardial disease associated with malignancy uptodate. The optimal management of npe has yet to be defined because randomized studies are lacking. This fast fact discusses the diagnosis and management of mpes. Neoplastic pericardial effusion, clinical cardiology 10. Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. This entity is entirely different from malignancyassociated pericardial effusions.
This study analyzed the current literature on the treatment of neoplastic pericardial effusion to provide advice and guidance for clinical treatment. The combination of fever and pleuropericardial effusion is an unusual presenting feature and raises the possibility of infectious, neoplastic and connective tissue disorders. It is, therefore, characterized as a late complication. As such, approaching dogs with a diagnosis of pericardial effusion can present challenges in decision making and client communication. The management of pericardial effusion in cancer patients.
Evaluation and management of pericardial effusion in patients. Suspected purulent or tuberculous pericardial effusion class lla effusions 1020 ml in echocardiography in diastole for diagnostic purposes other than purulent pericarditis or tuberculosis pericardial fluid and tissue analyses, pericardioscopy, and epicardialpericardial biopsy. Aims to evaluate the clinical efficacy, safety, and longterm effect of intrapericardial treatment with cisplatin in large neoplastic pericardial eff. In fact, in a study on 2700 breast cancer patients, seen from 1987 to 1997, symptomatic neoplastic pericardial effusion was only diagnosed in. Request pdf neoplastic pericardial effusion neoplastic pericardial effusion is a serious and common clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and. The gross appearance of the pericardial fluid is not useful in differentiating malignant from nonmalignant effusion 20. Surgical management of symptomatic pericardial effusion in patients with solid malignancies. The incidence and extent of pericardial involvement in neoplastic disease varies. We performed a retrospective study of 1 patients 54 % male with nct who underwent pericardiocentesis at niigata cancer center hospital between 1992 and 20. Review clinical update management of pericardial effusion massimo imazio1 and yehuda adler2 1department cardiology, maria vittoria hospital, via luigi cibrario 72, torino 10141, italy. Patients with acute pericarditis typically have a normal cxr. Echocardiography revealed a pericardial effusion, cardiac tamponade and focal thickening of the pericardium.
We challenge this pessimistic approach, and describe here our experience with seven patients with solid tumors, in whom. Cisplatin appeared to prevent recurrence of pericardial effusion during the. Severe pericardial effusion in patients with concurrent malignancy. Diagnosis of tuberculous aetiology in pericardial effusions. Sometimes, its cause is obviously related to an underlying general or cardiac disease, or to a syndrome of inflammatory or infectious acute pericarditis. Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsyresults from a pilot study. The diagnosis of tuberculous aetiology in pericardial effusions is important since the prognosis is excellent with specific treatment. Neoplastic pericardial effusion is a serious and common clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and radiation oncologists. Pericardial effusion is a common finding in everyday practice. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Malignant pericardial effusions palliative care network of. All patients underwent clinical examination, echocardiography, pericardiocentesis, pericardioscopy, and epicardial biopsy.
A malignant effusion specifically is an accumulation of fluid in the pericardial sac associated with malignant cells in either the effusive fluid or the pericardium or epicardium. The relatively little attention given in the literature to the problem of pericardial effusion in patients with cancer reflects the general attitude that if this complication is disclosed, the future of the patient is sealed, and therapy will not change his outcome. Surgical treatments include pericardial puncture, extension of catheter drainage, pericardial window, and surgical pericardiotomy. It can be achieved via a thoracotomy or through thoracoscopy. Pleuropericardial effusion as a presenting feature raises the possibility of infectious, neoplastic and connective tissue disorders. Pericardial effusion is a buildup of fluid in the pericardium. Pericardial constriction may develop a long time after the initial presentation of certain neoplastic diseases, and the prognosis after pericardiectomy is poor. Request pdf neoplastic pericardial effusion neoplastic pericardial effusion is a serious and common clinical disorder encountered by cardiologists. Treatment of neoplastic pericardial effusion in lung cancer. Intrapericardial treatment of neoplastic pericardial. A cytological examination of pericardial fluid confirmed the diagnosis of malignant pericardial effusion in 65% to 85% of cases 21. Pericardial effusion fluid around the heart is an abnormal accumulation of fluid in the pericardial cavity. Sep 16, 2011 neoplastic pericardial effusion is a clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and radiation oncologists. Although neoplastic pericardial effusion pe carries a poor prognosis, benign idiopathic pericardial effusion does not.
Read evaluation and management of pericardial effusion in patients with neoplastic disease, progress in cardiovascular diseases on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The immediate control of neoplastic pericardial effusions is mandatory for both the survival and quality of life of patients. Abstract neoplastic pericardial effusion is a serious and common. We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in npe patients. Clinical presentation varies, from asymptomatic pericardial effusion.
In the case of idiopathic pericarditis, this is the only approach that will. Prolonged pericardial drainage is performed until the volume of effusion obtained by intermittent pericardial aspiration every 46 h fall to anterior effusion p10 mm while the rate of success is only 58% with small, posteriorly located effusions. Evaluation and management of pericardial effusion in. Guidelines on the diagnosis and management of pericardial. The aetiology is varied infectious, neoplastic, autoimmune, metabolic, and drugrelated, being tuberculosis the leading cause of pericardial effusions. Management of neoplastic pericardial disease springerlink. Analysis of 26 patients original article pericardial disease is a malignancy complication found in 1. Between 1978 and 1990, 51 cases of pericardial effusion secondary to lung cancer were treated at the national cancer center hospital by creating a pericardial window, using the subxiphoid approach. The clinical features may not be distinctive and the diagnosis could be missed particularly with tamponade. Lung and breast carcinoma, haematological malignancies, and gastrointestinal cancer are the most common types of cancer involving the pericardium. Here we will discuss the presentation and management of pericardial disease associated with malignancy. Jun 25, 2016 malignant pericardial effusions deepak singh mark r.
A cytological examination of pericardial fluid confirmed the diagnosis of malignant pericardial effusion. Transthoracic echocardiography confirmed the presence of a large pericardial effusion with associated tamponade physiological features. Neoplastic pericardial effusion refaat 2011 clinical cardiology. In reality, neoplastic effusions are caused by one or more of the above 3 mechanisms. Diagnostic and therapeutic pericardiocentesis was performed and led to. Malignant pericardial effusion and cardiac tamponade are known complications of many advanced malignancies such as breast cancer, lung cancer, lymphomas and leukemias. This approach allows a definitive diagnosis, with histopathology. With the spread of hiv infection the incidence has increased. The presence of cardiac enlargement does not differentiate between pericardial effusion, pericardial wall thickness or cardiac chamber enlargement. At present, there is no accurate and effective method for treating neoplastic pericardial effusion. A chest computed tomography ct scan revealed the presence of a large pericardial effusion that had not been present on a previous similar study 3 weeks earlier figure 1a and b.
As such, approaching dogs with a diagnosis of pericardial effusion can present challenges in decision making. Characteristics of neoplastic cardiac tamponade and. 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, chairperson germany, petar m. Thoracic radiographs revealed pleural effusion and suggested pericardial effusion. Prognosis is very good in idiopathicviral pericarditis. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. In other cases, the effusion and its clinical consequences ie, cardiac tamponade and constrictive pericarditis are of primary importance.
Simultaneous pleuropericardial effusion secondary to obstructive uropathy is such a rare scenario with no report mentioned in the published. This allows the heart to move smoothly against other organs in the chest as it beats. Pericardial involvement in neoplastic diseases can have a varied presentation depending on the underlying aetiology and duration of illness. Diagnostic and therapeutic pericardiocentesis was performed and led to immediate but shortterm alleviation of the clinical signs.
In some cases, the clinical presentation of acute pericardial inflammation predominates, and the presence of excess pericardial fluid is clinically unimportant. Clinical update management of pericardial effusion massimo imazio1 and yehuda adler2 1department cardiology. Pericardial effusions with a cardiac tamponade constitute a surgical emergency and the pericardiocentesis represents the first class therapeutic recommendation. Methods and results out of the registry of 260 patients undergoing pericardiocentesis, 42 patients with neoplastic pericardial effusion 69% males, mean age 58. Primary tumours of the pericardium are extremely rare and include mesothelioma, sarcoma and teratoma. Neoplastic pericardial effusion refaat 2011 clinical. In a considerable number of patients with breast or lung cancer or with mediastinal lymphoma, in addition to direct involvement by the tumor, radiation therapy as well as systemic tumor treatment can also lead to pericardial effusion. Mere obstruction of the mediastinal lymphatic system draining the heart is inadequate to produce pericardial effusion. Oct 01, 2011 neoplastic pericardial effusion is a serious and common clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and radiation oncologists. Pericardiectomy is required in most primary pericardial diseases idiopathic pericarditis, neoplastic pericardial effusion, constructive pericarditis. Malignant pericardial effusions palliative care network. The diagnostic clue is usually the detection of neoplastic cells within the pericardial fluid or. The incidence of hepatic and renal dysfunction in critically ill patients. On other occasions, pericardial effusion is an unexpected finding that requires specific evaluation.
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. An overview of the etiology of pericardial disease, and the general presentation, diagnosis, and management of constrictive pericarditis and pericardial effusion are presented elsewhere. The pericardium is a 2layer sac that surrounds the heart. Neoplastic pericardial effusion constitutes a more difficult challenge because reaccumulation of pericardial fluid is a concern. The interval between cancer diagnosis and nct onset and the prognosis after pericardiocentesis may differ according to cancer type. A pericardial friction rub is found in up to 85% of patients. Acute haemorrhagic tamponade in cancer patients receiving. It may develop from direct extension or metastatic spread of the underlying malignancy.
Neoplastic pericardial effusion npe is a lifethreatening condition that can worsen clinical outcome in cancer patients. Diagnosis and management of pericardial effusion ncbi. Neoplastic pericardial effusion is a clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and radiation oncologists. Thoracoscopic pericardiectomy for the management of a. Simultaneous pleuropericardial effusion secondary to obstructive uropathy is such a rare scenario with no report mentioned in the. The sac normally contains a small amount of clear fluid between its layers. The prognosis of pericardial effusion depends on the underlying etiology10,11,15,16 being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study presence of malignant cells in pericardial fluid. Mechanistic classification of effusions is useful forhelping narrow the list of differential diagnoses in a patient, but often is not diagnostic of a specific disease i. Keywords heart neoplasms, pericardial effusion, pericardiectomy, pericarditis, constrictive, treatment outcome introduction constrictive pericarditis is the endstage of an. The diagnosis largely depends on histopathology of the pericardial tissue or culture of.
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