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[Cardiac tamponade as clinical manifestation of neoplastic process: presentation of 11 cases and review of the literature] [Article in Spanish] Garcia Vazquez E . Servicio de Medicina Interna, Centro Hospitalario Fundacion Jimenez Diaz, Madrid. We analyse the clinical presentation of pericardial effusion in patients with malignancy. The diagnostic sensibility of cytology of the pericardial effusion, current management strategies, recurrences and survival are considered. Retrospective single centre study (Fundacion Jimenez Diaz). Eleven patients with malignant pericardial effusion (period: 1992-1996). The most frequent symptom was dyspnea (100%); echocardiogram accuracy was 100% and the sensitivity of pericardial cytology 64%. 73% of all effusions were adenocarcinomas (87.5% of the lung). Pericardiocentesis was practised in 73% patients. Survival did not improve when adding radiotherapy, using local sclerotherapy or surgical pericardial windows (pericardiotomy (medium survival of 109 days). Those patients who died did not develop symptoms of hemodynamic clinical emergency. Prognostic of malignant cardiac tamponade is closely related to the extent of disease and its sensitivity to treatment. PMID: 10730401 [PubMed - indexed for MEDLINE]
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Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Laham RJ , Cohen DJ , Kuntz RE , Baim DS , Lorell BH , Simons M . Harvard-Thorndike Laboratory, Department of Medicine, Harvard Medical School, Boston, USA. OBJECTIVE--To investigate the clinical presentation and current management strategies of pericardial effusion in patients with malignancy. DESIGN--Retrospective single centre, consecutive observational study. SETTING--University hospital. PATIENTS--93 consecutive patients with a past or present diagnosis of cancer and a pericardial effusion, including 50 with a pericardial effusion > 1 cm. RESULTS--Of the 50 patients with pericardial effusions > 1 cm, most had stage 4 cancer (64%), were symptomatic at the time of presentation (74%), and had right atrial collapse (74%). Twenty patients were treated conservatively (without pericardiocentesis) and were less symptomatic (55% v 87%, P = 0.012), had smaller pericardial effusions (1.5 (0.4) v 1.8 (0.5), P = 0.02), and less frequent clinical (10% v 40%, P = 0.02) and echocardiographic evidence of tamponade (40% v 97%, P < 0.001) than the 30 patients treated invasively with initial pericardiocentesis (n = 29) or pericardial window placement (n = 1). Pericardial tamponade requiring repeat pericardiocentesis occurred in 18 (62%) of 29 patients after a median of 7 days. In contrast, only four (20%) of 20 patients in the conservative group progressed to frank clinical tamponade and required pericardiocentesis (P = 0.005 v invasive group). The overall median survival was 2 months with a survival rate at 48 months of 26%. Survival, duration of hospital stay, and hospital charges were similar with both strategies. By multivariable analysis, the absence of symptoms was the only independent predictor of long-term survival (relative hazards ratio = 3.2, P = 0.05). Survival was similar in the 43 patients with cancer and pericardial effusions of < or = 1 cm. CONCLUSION--Asymptomatic patients with cancer and pericardial effusion can be managed conservatively with close follow up. In patients with symptoms or clinical cardiac tamponade, pericardiocentesis provides relief of symptoms but does not improve survival and has a high recurrence rate. Surgical pericardial windows or possibly percutaneous balloon pericardiotomy should be used for recurrences and should be considered for initial treatment. PMID: 8624876 [PubMed - indexed for MEDLINE]