|
|
| (19 intermediate revisions by 4 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{Pericarditis}} | | {{Pericarditis in malignancy}} |
| | '''For patient information click [[Pericarditis (patient information)|here]]''' |
| | |
| | '''To go back to the main page on Pericarditis, click [[Pericarditis|here]].''' |
|
| |
|
| {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | | {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. |
|
| |
|
| ==Overview==
| | {{SK}} Neoplastic pericarditis; malignant pericarditis |
| Many malignant neoplasms such as [[lung cancer]], [[breast cancer]], [[esophageal cancer]], [[lymphomas]], [[melanomas]], [[kaposi's sarcoma]] and [[leukemia]]s may metastasize to [[pericardium]] causing [[pericarditis]], [[pericardial effusion|effusion]], [[cardiac tamponade]] and [[pericardial constriction]]. Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy<ref name="pmid16051963">{{cite journal| author=Gornik HL, Gerhard-Herman M, Beckman JA| title=Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. | journal=J Clin Oncol | year= 2005 | volume= 23 | issue= 22 | pages= 5211-6 | pmid=16051963 | doi=10.1200/JCO.2005.00.745 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16051963 }} </ref><ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref>. Among patients presenting with [[pericarditis]] or [[pericardial effusion]] with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%<ref name="pmid4050698">{{cite journal| author=Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J| title=Primary acute pericardial disease: a prospective series of 231 consecutive patients. | journal=Am J Cardiol | year= 1985 | volume= 56 | issue= 10 | pages= 623-30 | pmid=4050698 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4050698 }} </ref><ref name="pmid17502574">{{cite journal| author=Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A et al.| title=Indicators of poor prognosis of acute pericarditis. | journal=Circulation | year= 2007 | volume= 115 | issue= 21 | pages= 2739-44 | pmid=17502574 | doi=10.1161/CIRCULATIONAHA.106.662114 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17502574 }} </ref><ref name="pmid15904655">{{cite journal| author=Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E et al.| title=Relation of acute pericardial disease to malignancy. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 11 | pages= 1393-4 | pmid=15904655 | doi=10.1016/j.amjcard.2005.01.094 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15904655 }} </ref>.
| | ==[[Pericarditis in malignancy overview|Overview]]== |
| | |
| Malignancy related pericardial disease can manifest as [[pericarditis]], [[pericardial effusion]], [[cardiac tamponade]] or [[pericardial constriction]].
| |
| | |
| ==Epidemiology and demographics== | |
| In developed countries malignancy is the leading cause of [[cardiac tamponade]] secondary to [[pericardial effusion]]. Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy<ref name="pmid16051963">{{cite journal| author=Gornik HL, Gerhard-Herman M, Beckman JA| title=Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. | journal=J Clin Oncol | year= 2005 | volume= 23 | issue= 22 | pages= 5211-6 | pmid=16051963 | doi=10.1200/JCO.2005.00.745 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16051963 }} </ref><ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref>. Among patients presenting with [[pericarditis]] or [[pericardial effusion]] with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%<ref name="pmid4050698">{{cite journal| author=Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J| title=Primary acute pericardial disease: a prospective series of 231 consecutive patients. | journal=Am J Cardiol | year= 1985 | volume= 56 | issue= 10 | pages= 623-30 | pmid=4050698 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4050698 }} </ref><ref name="pmid17502574">{{cite journal| author=Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A et al.| title=Indicators of poor prognosis of acute pericarditis. | journal=Circulation | year= 2007 | volume= 115 | issue= 21 | pages= 2739-44 | pmid=17502574 | doi=10.1161/CIRCULATIONAHA.106.662114 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17502574 }} </ref><ref name="pmid15904655">{{cite journal| author=Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E et al.| title=Relation of acute pericardial disease to malignancy. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 11 | pages= 1393-4 | pmid=15904655 | doi=10.1016/j.amjcard.2005.01.094 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15904655 }} </ref>.
| |
|
| |
|
| [[Lung carcinoma|Carcinoma of the lung]] is the most common cause for pericardial effusion in malignancy accounting for approximately 40%. Another 40% of cases could be due to [[breast carcinoma]] and [[lymphomas]]. Carcinoma of GI tract, [[melanoma]], [[sarcomas]], and other neoplastic diseases are less common. | | ==[[Pericarditis in malignancy pathophysiology|Pathophysiology]]== |
|
| |
|
| [[Kaposi sarcoma]] and lymphomas associated with [[HIV]] were other neoplastic causes of pericardial effusion which accounted for 5% and 7% respectively<ref name="pmid10047635">{{cite journal| author=Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M| title=Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. | journal=Am Heart J | year= 1999 | volume= 137 | issue= 3 | pages= 516-21 | pmid=10047635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10047635 }} </ref> in one study and 15% together<ref name="pmid12934767">{{cite journal| author=Gowda RM, Khan IA, Mehta NJ, Gowda MR, Sacchi TJ, Vasavada BC| title=Cardiac tamponade in patients with human immunodeficiency virus disease. | journal=Angiology | year= 2003 | volume= 54 | issue= 4 | pages= 469-74 | pmid=12934767 | doi= | pmc= | url= }} </ref> in another series. However, with the use of [[antiretroviral agent]]s, the incidence of Kaposi carcinoma and subsequent pericardial effusion has considerably decreased. | | ==[[Pericarditis in malignancy causes|Causes]]== |
|
| |
|
| In regions where [[tuberculosis]] is not highly prevalent, malignancy may be the most common cause of a hemorrhagic effusion<ref name="pmid20728703">{{cite journal| author=Maisch B, Ristic A, Pankuweit S| title=Evaluation and management of pericardial effusion in patients with neoplastic disease. | journal=Prog Cardiovasc Dis | year= 2010 | volume= 53 | issue= 2 | pages= 157-63 | pmid=20728703 | doi=10.1016/j.pcad.2010.06.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20728703 }} </ref><ref name="pmid10593777">{{cite journal| author=Atar S, Chiu J, Forrester JS, Siegel RJ| title=Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? | journal=Chest | year= 1999 | volume= 116 | issue= 6 | pages= 1564-9 | pmid=10593777 | doi= | pmc= | url= }} </ref>
| | ==[[Pericarditis differential diagnosis|Differentiating Pericarditis in malignancy from other Diseases]]== |
|
| |
|
| ===Sex=== | | ==[[Pericarditis in malignancy epidemiology and demographics|Epidemiology and Demographics]]== |
| Higher incidence of the pericardial effusion related to malignancy is observed among males with ratio of 7:3 as reported in a series<ref name="pmid8632279">{{cite journal| author=Medary I, Steinherz LJ, Aronson DC, La Quaglia MP| title=Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage. | journal=J Pediatr Surg | year= 1996 | volume= 31 | issue= 1 | pages= 197-9; discussion 199-200 | pmid=8632279 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8632279 }} </ref>
| |
|
| |
|
| ==Natural history, prognosis and complications== | | ==[[Pericarditis in malignancy natural history|Natural History, Complications and Prognosis]]== |
| Gaurded prognosis associated with malignancies is worsened by [[pericardial effusion]] and [[cardiac tamponade]]. Children may have poor prognosis and thus, prompt detection and treatment of cardiac tamponade improves survival<ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid16719168">{{cite journal| author=Bień E, Stefanowicz J, Aleszewicz-Baranowska J, Połczyńska K, Szołkiewicz A, Stachowicz-Stencel T et al.| title=[Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]. | journal=Med Wieku Rozwoj | year= 2005 | volume= 9 | issue= 3 Pt 2 | pages= 551-9 | pmid=16719168 | doi= | pmc= | url= }} </ref>.
| |
| | |
| Patients rarely present with cardiac tamponade as their first presentation. [[Superior vena cava syndrome]] may occur in few secondary to either coexisting tumor or rapid accumulation of pericardial effusion<ref name="pmid19956024">{{cite journal| author=Tsai MH, Yang CP, Chung HT, Shih LY| title=Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. | journal=J Pediatr Hematol Oncol | year= 2009 | volume= 31 | issue= 12 | pages= 980-2 | pmid=19956024 | doi=10.1097/MPH.0b013e3181b86ff3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19956024 }} </ref>.
| |
| | |
| Prognosis of symptomatic malignant pericardial disease is grave with a short life expectancy of 2-4 months<ref name="pmid10725950">{{cite journal| author=Tsang TS, Seward JB, Barnes ME, Bailey KR, Sinak LJ, Urban LH et al.| title=Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. | journal=Mayo Clin Proc | year= 2000 | volume= 75 | issue= 3 | pages= 248-53 | pmid=10725950 | doi= | pmc= | url= }} </ref><ref name="pmid17028771">{{cite journal| author=Gross JL, Younes RN, Deheinzelin D, Diniz AL, Silva RA, Haddad FJ| title=Surgical management of symptomatic pericardial effusion in patients with solid malignancies. | journal=Ann Surg Oncol | year= 2006 | volume= 13 | issue= 12 | pages= 1732-8 | pmid=17028771 | doi=10.1245/s10434-006-9073-1 | pmc= | url= }} </ref><ref name="pmid15078742">{{cite journal| author=Cullinane CA, Paz IB, Smith D, Carter N, Grannis FW| title=Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. | journal=Chest | year= 2004 | volume= 125 | issue= 4 | pages= 1328-34 | pmid=15078742 | doi= | pmc= | url= }} </ref><ref name="pmid18648881">{{cite journal| author=Dequanter D, Lothaire P, Berghmans T, Sculier JP| title=Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. | journal=Ann Surg Oncol | year= 2008 | volume= 15 | issue= 11 | pages= 3268-71 | pmid=18648881 | doi=10.1245/s10434-008-0059-z | pmc= | url= }} </ref>. While the patients with hematologic<ref name="pmid12853529">{{cite journal| author=Dosios T, Theakos N, Angouras D, Asimacopoulos P| title=Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. | journal=Chest | year= 2003 | volume= 124 | issue= 1 | pages= 242-6 | pmid=12853529 | doi= | pmc= | url= }} </ref> or breast cancer<ref name="pmid9386714">{{cite journal| author=Girardi LN, Ginsberg RJ, Burt ME| title=Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusions. | journal=Ann Thorac Surg | year= 1997 | volume= 64 | issue= 5 | pages= 1422-7; discussion 1427-8 | pmid=9386714 | doi=10.1016/S0003-4975(97)00992-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9386714 }} </ref>, or those in whom malignant cells are not present in pericardium<ref name="pmid18329349">{{cite journal| author=Neragi-Miandoab S, Linden PA, Ducko CT, Bueno R, Richards WG, Sugarbaker DJ et al.| title=VATS pericardiotomy for patients with known malignancy and pericardial effusion: survival and prognosis of positive cytology and metastatic involvement of the pericardium: a case control study. | journal=Int J Surg | year= 2008 | volume= 6 | issue= 2 | pages= 110-4 | pmid=18329349 | doi=10.1016/j.ijsu.2007.12.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18329349 }} </ref> have better prognosis in comparison to those with solid tumors, lung cancer<ref name="pmid11480719">{{cite journal| author=García-Riego A, Cuiñas C, Vilanova JJ| title=Malignant pericardial effusion. | journal=Acta Cytol | year= 2001 | volume= 45 | issue= 4 | pages= 561-6 | pmid=11480719 | doi= | pmc= | url= }} </ref>, etc. | |
| | |
| ==Pathophysiology==
| |
| Pericardium may be involved by direct local spread from neoplasms such as [[breast carcinoma|breast]] and [[lung carcinoma]]s or by metastatic spread via blood stream and lymphatics as in [[melanomas]], [[lymphomas]] and [[leukemias]].
| |
| | |
| [[Pericardial effusion]] in such situations may occur either secondary to pericardial inflammation or obstruction of lymphatic drainage by enlarged [[mediastinal nodes]]<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056 }} </ref><ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid15904655">{{cite journal| author=Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E et al.| title=Relation of acute pericardial disease to malignancy. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 11 | pages= 1393-4 | pmid=15904655 | doi=10.1016/j.amjcard.2005.01.094 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15904655 }} </ref>.
| |
| | |
| ==Etiology==
| |
| #Pericardial [[mesothelioma]]
| |
| #[[Fibrosarcoma]]
| |
| #[[Wilms tumor]]
| |
| #[[Hodgkin lymphoma]]
| |
| #Primary mediastinal (thymic) [[B-cell lymphoma]]
| |
| #[[Adenocarcinoma]]
| |
| #[[Angiosarcoma]]
| |
| #[[Sarcomas]]
| |
| #[[Non-Hodgkin lymphoma]]
| |
| #[[Liposarcoma]]
| |
| #[[Pheochromocytoma]]
| |
| #[[Lymphoma]]
| |
| #Malignant pericardial [[teratoma]]
| |
| #[[Rhabdomyosarcoma]] with [[tuberous sclerosis]]
| |
| #[[Pheochromocytoma]]
| |
| #[[Neuroblastoma]]
| |
| #Ganglioneuroblastoma
| |
| #Leiomyosarcomas
| |
| #Liposarcomas
| |
| #High-grade sarcomas
| |
| #[[Burkitt lymphoma]]
| |
| #[[Kaposi sarcoma]] and primary cardiac lymphoma in association with [[human immunodeficiency virus]] ([[HIV]]) infection
| |
| #Intrapericardial teratoma in the fetus and neonate
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| ===History and symptoms===
| | [[Pericarditis in malignancy history and symptoms|History and Symptoms]] | [[Pericarditis in malignancy physical examination|Physical Examination]] | [[Pericarditis laboratory studies|Laboratory Findings]] | [[Pericarditis in malignancy electrocardiogram|Electrocardiogram]] | [[Pericarditis in malignancy chest x ray|Chest X Ray]] | [[Pericarditis CT|CT]] | [[Pericarditis MRI|MRI]] | [[Pericarditis in malignancy echocardiography or ultrasound|Echocardiography]] | [[Pericarditis in malignancy cardiac catheterization|Cardiac Catheterization]] |
| In addition to malignancy specific presentation, patients may present with the following symptoms due to pericardial involvement:
| |
| *[[Fever]]
| |
| *[[Chest pain]] that improves on leaning forward and worsens on inspiration
| |
| *[[Breathlessness]]
| |
| *[[Orthopnoea]]
| |
| *[[Dizziness]]
| |
| *[[Palpitation]]
| |
| *[[Malaise]]
| |
| *[[Ankle edema]]
| |
| *[[Weight loss]]
| |
| | |
| Many patients may be asymptomatic and pericardial involvement may be detected incidentally on chest x-ray or on [[autopsy]].
| |
| | |
| ===Physical examination===
| |
| [[Cachexia]], weight loss and other organ-system specific abnormalities secondary to malignancy.
| |
| | |
| '''Vitals:''' [[Tachycardia]], [[pulsus paradoxus]] and [[hypotension]](in [[cardiac tamponade]])
| |
| | |
| '''Neck:''' [[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]]
| |
| | |
| '''Chest:''' Pericardial knock, [[pericardial rub]] and distant [[heart sounds]]
| |
| | |
| '''Abdomen:''' [[Hepatomegaly]], [[ascites]]
| |
| | |
| '''Extremities:''' [[Ankle edema]]
| |
| | |
| ===Electrocardiography===
| |
| *Characteristic ST elevations with PR depression may be noted in all leads in presence of [[pericarditis]].
| |
| *In case of [[pericardial effusion]] or [[cardiac tamponade]], micro-voltage with [[electical alternans]] may be observed which could be due to swinging motion of heart in pool of pericardial fluid.
| |
| *Constrictive pericarditis may present with ECG changes consistent with [[atrial fibrillation]].
| |
|
| |
|
| [[Image:Alternans.jpg|500px|left|thumb|Electrical alternans in cardiac tamponade]] | | ==Treatment== |
| <br clear="left"/>
| | [[Pericarditis in malignancy approach to treatment|Approach to Treatment]] | [[Pericarditis treatment|Medical Therapy]] | [[Pericardiocentesis]] | [[Pericardial window|Pericardial Window]] | [[Pericardial stripping|Pericardial Stripping]] |
|
| |
|
| ===Chest X-ray=== | | ==Case Studies== |
| Enlarged cardiac silhouette may be noted in pericardial effusion. Pericardial calcifications may be noted in constrictive pericarditis
| | [[Pericarditis in malignancy case study one|Case #1]] |
| [[Image:Pericardial calcification.jpg|400px|left|thumb|Pericardial calcification]] | |
| <br clear="left"/>
| |
| | |
| ===Echocardiography===
| |
| Echocardiography facilitates in visualizing the fluid accumulation within the pericardial cavity. Pericardial or myocardial tumors if present can also be noted.
| |
| | |
| Echocardiogram demonstrating '''Pericardial effusion''' and '''Myocardial tumor'''
| |
| <youtube v=sGTttwrx2xw/>
| |
| | |
| ===MRI and CT===
| |
| MRI and CT of chest and abdomen helps us in visualizing the presence of tumor/malignancy and the degree of metastasis to other parts of the body in addition to pericardial involvement. They are superior to echocardiography<ref name="pmid7622713">{{cite journal| author=Bellon RJ, Wright WH, Unger EC| title=CT-guided pericardial drainage catheter placement with subsequent pericardial sclerosis. | journal=J Comput Assist Tomogr | year= 1995 | volume= 19 | issue= 4 | pages= 672-3 | pmid=7622713 | doi= | pmc= | url= }} </ref> in terms of providing information about whether an effusion is hemorrhagic or loculated and also in differentiating hematoma from tumor.
| |
| | |
| ===Pericardiocentesis===
| |
| Pericardial fluid should be aspirated and tested for presence of malignant cells and tumor markers particularly in patients with hemorrhagic effusion without preceding trauma<ref name="pmid10593777">{{cite journal| author=Atar S, Chiu J, Forrester JS, Siegel RJ| title=Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? | journal=Chest | year= 1999 | volume= 116 | issue= 6 | pages= 1564-9 | pmid=10593777 | doi= | pmc= | url= }} </ref>. However, hemorrhagic pericarditis in developing countries could be due to [[tuberculosis]]. Sensitivity of [[cytology|cytological]] analysis of pericardial fluid for malignant cells were 67%<ref name="pmid2028688">{{cite journal| author=Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U| title=The diagnostic value of pericardial cytology. An analysis of 95 cases. | journal=Acta Cytol | year= 1991 | volume= 35 | issue= 2 | pages= 149-53 | pmid=2028688 | doi= | pmc= | url= }} </ref>, 75%<ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref> and 92%<ref name="pmid9149572">{{cite journal| author=Meyers DG, Meyers RE, Prendergast TW| title=The usefulness of diagnostic tests on pericardial fluid. | journal=Chest | year= 1997 | volume= 111 | issue= 5 | pages= 1213-21 | pmid=9149572 | doi= | pmc= | url= }} </ref> in different studies with specificity of 100%. [[Immunohistochemistry]] can be used to distinguish between the malignant cells and their possible origin<ref name="pmid12508174">{{cite journal| author=Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW| title=Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block. | journal=Diagn Cytopathol | year= 2003 | volume= 28 | issue= 1 | pages= 1-5 | pmid=12508174 | doi=10.1002/dc.10219 | pmc= | url= }} </ref><ref name="pmid9068950">{{cite journal| author=Mayall F, Heryet A, Manga D, Kriegeskotten A| title=p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology. | journal=Cytopathology | year= 1997 | volume= 8 | issue= 1 | pages= 9-12 | pmid=9068950 | doi= | pmc= | url= }} </ref>.
| |
| | |
| ===Pericardial biopsy===
| |
| Negative cytology should be followed with by pericardial biopsy performed via a subxiphoid or transthoracic [[pericardiostomy]] or by [[pericardioscopy]]. The pericardioscopy which helps in direct visualization of pericardium and collecting biopsy sample, has a good sensitivity of 97%<ref name="pmid10554845">{{cite journal| author=Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ| title=Pericardoscopy for primary management of pericardial effusion in cancer patients. | journal=Eur J Cardiothorac Surg | year= 1999 | volume= 16 | issue= 3 | pages= 287-91 | pmid=10554845 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10554845 }} </ref><ref name="pmid8840855">{{cite journal| author=Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A et al.| title=Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. | journal=Circulation | year= 1996 | volume= 94 | issue= 7 | pages= 1635-41 | pmid=8840855 | doi= | pmc= | url= }} </ref> when compared to blind biopsy which has a low sensitivity of 55-65%.
| |
| | |
| ===Cardiac catheterization===
| |
| *'''[[Cardiac tamponade]]:''' There is equalization of pressures in all four chambers of heart. The right atrial pressure equals the right ventricular end diastolic pressure equals the pulmonary artery diastolic pressure.
| |
| *'''[[Constrictive pericarditis]]:''' Equalization of elevated right atrial and pulmonary artery wedge pressures may be noted with a diastolic dip and plateau in the right ventricular tracing.
| |
| *'''[[Effusive constrictive pericarditis]]:''' Cardiac tamponade findings are noted initially. Findings of constrictive pericarditis are unmasked following [[pericardiocentesis]].
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
|
| |
|
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| Line 127: |
Line 34: |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Oncology]] | | [[Category:Oncology]] |
| | | [[Category:Disease]] |
| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | [[Category:Up-To-Date]] |
| | [[Category:Oncology]] |
| | [[Category:Medicine]] |
| | [[Category:Cardiology]] |
| | [[Category:Surgery]] |