Concurrent pleural and pericardial effusions in advanced lung adenocarcinoma: a case report (original) (raw)
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The Management of Malignant Pleural and Pericardial Effusions
Hematology/Oncology Clinics of North America, 1997
Malignant pleural effusions (MPEs) are a significant cause of morbidity in patients with advanced cancer. Approximately 43 cases of MPE are diagnosed for every 100,000 hospital admissions, or 100,000 new cases per year in the United States.8, 25 MPEs are most commonly associated with lung and breast carcinoma, accounting for 75% of all MPE.25 Other common causes include lymphoma, gastric cancer, ovarian cancer, and adenocarcinoma of unknown primary.16, 36 Approximately two thirds of MPEs occur in women owing to .the predominant association of MPE with breast and ovarian cancer." Half of all pleural effusions in adults are due to malignancy and are exudates. Transudative effusions may also occur in patients with advanced malignancies. The transudate may be secondary to hypoalbuminemia, congestive heart failure, or hepatic disease from metastases. These effusions are usually small and rarely symptomatic.
Concurrent pericardial and pleural effusions: a double jeopardy
Journal of Clinical Anesthesia, 2016
A 19-year-old man with large malignant pleural and pericardial effusions with tamponade physiology and signs of congestive heart failure presented for emergent subxiphoid pericardial window. Surgical drainage of the pericardium was complicated by a paradoxical cardiovascular collapse that failed to respond to pressors and intravenous fluids. Suspecting a pericardial perforation, a median sternotomy was performed and revealed an intact heart. The arterial pressure was promptly restored after drainage of the pleural effusion. It is proposed that, in patients presenting with tamponading pericardial and pleural effusions, drainage of the pleural effusion be given priority. The pathophysiology of low cardiac output states resulting from pericardial and large pleural effusion is discussed and the literature reviewed.
Malignant Pericardial Effusion Secondary to Lung Adenocarcinoma: Case Report
Edición 20 (1) Neonatal Mortality; Carga de Cuidado; Infección Hospitalaria , 2017
Introduction: Malignant pericardial effusion is the accumulation of liquid in the pericardial space secondary to advanced stage neoplasia, becoming in an indicator of bad prognosis. Malignant tumors that are most often related to this entity are the ones from pulmonary, mammary, and hematolymphoid origin. Clinically, it may present imminent signs of cardiac tamponade and hemodynamic instability, so that it merits an early diagnosis and management with emerging decompression maneuvers. Objective: This article presents a malignant pericardial effusion case, since this clinical condition implies a diagnostic challenge. Case presentation and Conclusions: A case of a 63 year old male patient is presented. He has one month of clinical evolution characterized by cervical adenopathies, also in the past fifteen days has been presenting precocious satiety, nocturnal sweating, sensation of distended abdomen, and functional class deterioration to having dyspnea during small physical efforts. This was the reason why he went to the emergency room. During the medical observation, the patient quickly deteriorates to hemodynamic instability, refractory to treatment. Some imaging studies were performed, which show severe pericardial effusion so a decompressive pericardiocentesis and a multidisciplinary integral management were performed. [Chilatra-Fonseca JM, Morales-Camacho WJ, Plata-Ortiz JE, Gómez-Mancilla YP, Villabona-Rosales SA. Malignant Pericardial Effusion Secondary to Lung Adenocarcinoma: Case Report. MedUNAB 2017; 20(1): 63-69].
Primary peritoneal adenocarcinoma causes pleural effusion
North American journal of medical sciences, 2010
The most common malignancies associated with malignant pleural effusions are carcinomas of the breast, lung, gastrointestinal tract, ovary and lymphomas. Primary peritoneal adenocarcinoma is a very rare cause of malignant pleural effusion. A 72-year old female patient presented to us with shortness of breath for the last 2 months. A contrast-enhanced computed tomography (CECT) scan of her-thorax revealed only bilateral pleural effusion with absence of any mass lesion or any mediastinal lymphadenopathy. A cytologic examination of pleural fluid revealed adenocarcinoma cells. A CECT of her abdomen and pelvis revealed heterogenous thickening of omentum with nodular appearances and small amount of ascites. Her ovaries were normal and no other mass lesion was detected. A histological examination of a peritoneal lesion was suggestive of adenocarcinoma. The patient was diagnosed with a rare case of primary peritoneal adenocarcinoma with bilateral pleural effusion.
Recurrent Malignant Pleural Effusion in Lung Cancer Adenocarcinoma patient
2020
Background: Pleural effusion is associated with diseases including malignancies, infections, autoimmune diseases and trauma. Carcinomas of the lung, breast and lymphomas frequently cause malignant pleural effusions. Lung adenocarcinoma is especially associated with malignant pleural effusion, indicating advanced stage disease or disease progression. This case reporting 61 years old, Malay lady was experienced symptoms of worsening shortness of breath, frequently coughing with whitish sputum and also complained unable to ambulate for long distance and inability to lie flat. On 22/10/2019, patient came to Lung Cancer Clinic as follow up. On examination noted that patient feeling of chest tightness and chest X-ray found evidence of recurrent pleural effusion. Ultrasound Guided thorax done with chest tube insertion done on 24/10/2019. Pleurodesis was done to prevent recurrent pleural effusion.
Chest, 2004
Background: Pericardial effusion in the patient with cancer presents a unique management problem. Although multiple methods of operative and nonoperative drainage of pericardial effusions have been described, surgical pericardial window remains the standard approach to long-term drainage. Selecting the patient who may benefit from an operative approach presents a difficult challenge. In the present study, we retrospectively analyzed the clinical outcome of 63 consecutive patients with malignancy who underwent surgical pericardial window for symptomatic pericardial effusion between January 1, 1990, and July 1, 2001, at City of Hope National Medical Center in order to try to determine whether the type of cancer, the presence of malignant cells in pericardial fluid, or tissue specimens or the method of surgery influenced the incidence of recurrent pericardial effusion or duration of survival. Methods: The cohort was comprised of 15 patients with non-small cell lung cancer (NSCLC), 22 patients with breast cancer, 17 patients with hematologic malignancy, and 9 patients with other solid tumors. Pertinent clinical, laboratory, hospital stay, and outcome data including long-term follow-up were recorded. Patients were followed up until the time of last clinical follow-up or death. Univariate survival analyses were performed to determine significant clinical factors contributing to outcome. Results: Median follow-up was 6.6 months for the group and 8.3 months for those alive at last follow-up. Median survival rates for patients with lung, breast, hematologic, and other solid-tumor malignancies were 3.2 months, 8.8 months, 17 months, and 16.4 months, respectively. Preoperative factors that negatively correlated with survival included a diagnosis of NSCLC (p ؍ 0.0014), the presence of a pleural effusion (p ؍ 0.003), or positive pathologic (p ؍ 0.02) or cytologic findings (p ؍ 0.02). Conclusions: A surgical approach to pericardial drainage is effective (< 5% failure rate) and provides an opportunity for continued therapy with the potential for relief of dyspnea and improvement in quality of life and survival in selected patients.
Annals of Surgical Oncology, 2008
Background: The treatment of massive and/or symptomatic pericardial effusion in patients with cancer remains a subject of discussion. Medical and surgical management have been proposed. In the present study, we aimed to determine the prognostic factors influencing survival of cancer patients admitted in intensive care unit (ICU) with severe pericardial effusion to better select the treatment strategies. Methods: All patients with cancer and massive or symptomatic pericardial effusion were retrospectively analyzed. Patients were followed up until death or last time known to be alive. Univariate and multivariate analyses were performed to determine prognostic factors influencing survival. Results: Between January 1999 and August 2004, 55 eligible patients were admitted in the ICU for pericardial effusion, including 30 with lung cancer, 9 with breast cancer, 5 with hematological malignancies, and 11 patients with other types of solid tumors. Forty-three patients underwent a surgical drainage. No operative death occurred. Four patients presented with an asymptomatic recurrence. Median survival of the entire group was 112 days. Survival rates for 1, 2, and 3 years were 27%, 17%, and 12%, respectively. In univariate analysis, the following variables were significantly associated with a reduced survival: histopathological diagnosis of malignant pericardial effusion, age (>60 years), the volume of pericardial effusion (<550 cc), and the cancer status (complete or partial response). After multivariate analysis, the cancer status was the only statistically significant clinical factor influencing overall survival (P = .005). Conclusion: In this series of patients presenting with severe pericardial effusion, the control of the underlying neoplasm was the only significant factor influencing survival and could be helpful in making decision to the optimal (invasive) treatment that should balance treatment efficacy with life expectancy.
ACI (Acta Cardiologia Indonesiana)
Pericardial effusion associated with malignacy has poor prognosis. The prompt identification of etiology is mandatory, such that timely management can be performed and survival can be increased. However, difficulty in etiology determination is commonly encountered. In this case, we report female patient with relapse stage IV breast cancer who develop massive pericardial and bilateral pleural effusion. The similar characteristics were found in both effusion fluids, however the identification of etiology was not similar. Metastatic cells were found in pleural effusion, whereas they were absent in pericardial effusion.
Cureus
Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-yearold female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion, left upper lobe mass, possible lymphangitic spread of carcinoma in the left lung, and adenopathy in the mediastinum. The echocardiography findings further confirmed tamponade. Cardiology and pulmonary medicine were taken on board for a possible malignancy associated pleural effusion leading to cardiac tamponade. Pericardial fluid analysis showed atypical cells suggestive of malignancy. Transbronchial biopsy confirmed moderately differentiated invasive adenocarcinoma. Positron emission tomography (PET) scan revealed metastatic spread to the mediastinum and right hilum with possible pleural metastatic disease seen posteriorly in the left hemithorax. The patient was discharged home with oncology follow up for chemotherapy.