[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.

[Bronchopericardial fistula treatment by a metallic stent]

INTRODUCTION

Bronchopericardial fistula is a rare condition leading to pneumopericardium. This medical condition is often related to neoplastic disease, or a complication of surgical interventions. The treatment approach depends on both the etiology and the clinical presentation. In stable patients, pericardial drain insertion and/or surgical resection of the fistula are considered options for persistent cases. We present the case of a bronchopericardial fistula treated by placement of an endobronchial stent.

CASE PRESENTATION

A 64-year-old man operated on for lung cancer had a recurrence treated with radiation and chemotherapy. A pneumopericadium was discovered when he presented with a new onset of atrial fibrillation. Bronchoscopy revealed a fistula tract. Pericardial drainage was persistent and did not improve the clinical situation. The poor health status of the patient contraindicated surgery and an alternative therapeutic approach with endobronchial stent placement was undertaken. The fistula sealed immediately, the pericardial drain could be removed removed and the patient was able to be discharged from hospital.

CONCLUSION

Endobronchial stenting should be considered as a potential treatment option in patients with pneumopericardium secondary to bronchopericadial fistula, particularly where a non-surgical is required.