A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder

Abstract

A 62-year-old man presented with 2 weeks of progressive dyspnea and chest pain. He was previously diagnosed with high-grade invasive urothelial carcinoma (UC) of the bladder and underwent neoadjuvant chemotherapy followed by radical cystectomy 10 months earlier, resulting in pathologic complete remission. Clinical evaluation and echocardiographic imaging was consistent with a diagnosis of cardiac tamponade. Due to a history of malignancy, the patient was referred for a surgical pericardial window, to include biopsy of the pericardium. Pericardial fluid and pericardial biopsy specimens were consistent with metastatic UC. Cardiac tamponade due to metastatic UC is a rare presentation, and, to our knowledge, there have been only 5 cases reported in the English literature. We report a rare case of cardiac tamponade due to isolated pericardial metastases from high grade UC of the bladder and discuss the symptoms, treatment, and prognosis of this pathologic condition. We also present a brief review of previously published literature. Through this discussion, we would like to emphasize the (1) consideration of cardiac metastases in the differential diagnosis for patients with a history of UC presenting with cardiac or pulmonary symptoms and (2) improved diagnostics with pericardial biopsy and pericardiocentesis over pericardiocentesis alone.

Urothelial bladder cancer with cardiac metastasis: Literature review and case report

“…The analysis of 20 studies, plus our case report totaled 30 patients described between 1934 and 2023, proving the rarity of cardiac metastasis of TCC [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Data in showed that patients with cardiac metastasis from TCC are predominantly men (77.78 %), mean age 65.47 years, most patients were diagnosed after death by autopsy (57.90 %) ( Table 1 and Fig.…”

“…Most diagnoses occurred with the aid of cystoscopy and transurethral resection. 18 studies [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]reported some type of treatment administered after a diagnosis of TCC, most patients were treated with radical cystectomy (50.00 %), chemotherapy (neoadjuvant or adjuvant) (44.45 %), and bladder reconstruction or urinary diversion (33.34 %) ( Table 1 ).

Fig.

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“…The most used exams for the diagnosis of cardiac metastasis were transthoracic echocardiogram (53.34 %), computed tomography (46.67 %), chest X-ray (23.34 %), electrocardiogram (16.67 %), and the diameter of the metastasis ranged from 1.3 to 7.0 cm, mean 5.20 cm. Twelve papers [ 8 , 9 , [14] , [15] , [16] , [18] , [19] , [20] , [21] , [22] , [23] ] reported pericardial effusion, and 6 papers [ 8 , 9 , 15 , [20] , [21] , [22] ] reported cardiac tamponade, and 8 papers [ 8 , 9 , [14] , [15] , [16] , [20] , [21] , [22] ] described diagnostic pericardiocentesis. The drained volume ranged from 700 to 2000 ml, mean of 1040 ml; 6 studies [ 8 , 9 , 14 , [20] , [21] , [22] ] had information on positive oncotic cytology, and of the 6 cardiac biopsies [ 10 , 11 , [14] , [15] , [16] ] reported, 4 biopsies [ 11 , [14] , [15] , [16] ] (83.34 %) were confirmed as cardiac metastasis.…”

Cardiac and Intramuscular Metastases Following Nephroureterectomy for Metachronous Urothelial Carcinoma

“…In our literature review, we found that cardiac metastasis from renal cancer (encompassing all histological subtypes) have been reported to be intra-atrium [ 9 , 10 ], intra-ventricular [ 11 , 12 ], myocardial [ 13 , 14 ], endocardial [ 9 ], pericardial [ 15 , 16 ], or involving multiple regions of the heart [ 9 , 14 ]. Cardiac metastasis can be asymptomatic or can present with life-threatening complications such as tamponade, outflow tract obstruction, arrhythmias, or valvular dysfunction [ 16 – 18 ]. Apart from routine transthoracic echocardiography, further imaging such as contrast-enhanced ultrasound, cardiac CT, cardiac MRI, or PET CT scan can be performed for further evaluation.…”

Corrigendum to “A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder”

“…In the article titled “A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder” [1], Dr. Amrou Abdelkader was missing from the authors' list. Dr. Amrou Abdelkader was involved in writing and editing the pathology portion of the article and providing the pathology photos (Figures 3(a)–3(d)) and the associated legend.…”