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| {{Pericarditis}} | | {{Pericarditis in malignancy}} |
| | '''For patient information click [[Pericarditis (patient information)|here]]''' |
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| | '''To go back to the main page on Pericarditis, click [[Pericarditis|here]].''' |
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| {{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. |
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| ==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]]== |
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| Malignancy related pericardial disease can manifest as [[pericarditis]], [[pericardial effusion]], [[cardiac tamponade]] or [[pericardial constriction]].
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| ==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>.
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| [[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.
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| [[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.
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| 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 in malignancy pathophysiology|Pathophysiology]]== |
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| ===Sex=== | | ==[[Pericarditis in malignancy causes|Causes]]== |
| 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>
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| ==Natural history, prognosis and complications== | | ==[[Pericarditis differential diagnosis|Differentiating Pericarditis in malignancy from other Diseases]]== |
| 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>.
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| Patients rarely present with cardiac tamponade as their first presentation. [[Superior venacava 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>.
| | ==[[Pericarditis in malignancy epidemiology and demographics|Epidemiology and Demographics]]== |
| ==Pathophysiology==
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| 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]].
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| [[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>. | | ==[[Pericarditis in malignancy natural history|Natural History, Complications and Prognosis]]== |
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| ==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:
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| *[[Fever]]
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| *[[Chest pain]] that improves on leaning forward and worsens on inspiration
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| *[[Breathlessness]]
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| *[[Orthopnoea]]
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| *[[Dizziness]]
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| *[[Palpitation]]
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| *[[Malaise]]
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| *[[Ankle edema]]
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| Many patients may be asymptomatic and pericardial involvement may be detected incidentally on chest x-ray or on [[autopsy]].
| | ==Treatment== |
| | [[Pericarditis in malignancy approach to treatment|Approach to Treatment]] | [[Pericarditis treatment|Medical Therapy]] | [[Pericardiocentesis]] | [[Pericardial window|Pericardial Window]] | [[Pericardial stripping|Pericardial Stripping]] |
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| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | [[Pericarditis in malignancy case study one|Case #1]] |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
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| [[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]] |