Pericardial effusion in a patient with advanced lung cancer

[Management of malignant pericardial effusion in lung cancer]

Acute pericarditis associated with lung cancer is a relatively frequent complication but is usually not symptomatic unless it causes tamponade. The clinical presentation is classically with dyspnea, thoracic pain, signs of right cardiac failure then left cardiac failure and syncope but it is often a difficult diagnosis in a patient with multi-symptomatic disease. The diagnosis is based on cardiac echography. Toxicity due to radiotherapy or more rarely an infectious etiology must be considered. Clinically significant effusions must be drained because of the high rate of recurrence after a simple aspiration. Drainage is formally indicated when, at echocardiography, the effusion exceeds 20mm in diastole, in cases of tamponade or in cases of compromised hemodynamic status. The formation of a pericardial window at thoracotomy prevents recurrences. Based on old, retrospective, very heterogeneous case series the prognosis, is generally considered to be poor with a median survival which does not exceed 100 days and a one year survival generally lower than 10%. Prognosis is better where diagnosis occurs at an earlier stage allowing regular follow-up and surgical intervention in a non-emergency setting.

Impending cardiac tamponade: A case report highlighting the value of bedside echocardiography

Cardiac tamponade is a life-threatening process that must be diagnosed and treated in a timely fashion. As blood fills the pericardial sac, right ventricular filling is impeded and cardiac output is diminished, ultimately leading to cardiovascular collapse. Fortunately, emergency ultrasonography has improved the way we manage these patients today. In this report, we discuss a patient with hypotension and tachycardia who was found to have a massive loculated posterior pericardial effusion with impending cardiac tamponade. The diagnosis and appropriate treatment of this patient were rapidly ascertained with the use of bedside echocardiography. We review the literature on emergency ultrasonography, and consider the numerous instances in which emergency echocardiography can be life-saving.