Cardiac Tamponade as the Initial Presentation of Metastatic Esophageal Adenocarcinoma

Abstract

Malignancy accounts for approximately 15-20% of moderate to large pericardial effusions. Pulmonary and colon are the most common primary causes. Large pleural effusions tend to present with a less dramatic clinical picture. It is because fluids tend to build up slowly, giving enough time to the pericardial sac to accommodate it until pressure reaches a critical value causing right heart chambers to collapse. In this report, we present the case of a 51-year-old male with cardiac tamponade as the first manifestation of esophageal adenocarcinoma. The patient presented with shortness of breath and pleuritic chest pain for one week, with no other associated symptoms. Early workup indicated a cardiac tamponade likely secondary to lung malignancy. Further workup demonstrated that the primary source was an esophageal malignancy. In this setting, pericardial effusions are usually related to radiation/chemotherapy, but in rare cases, cardiac tamponade can be the first manifestation of esophageal cancer.

Acute pericarditis as the presenting symptom of a case of oesophageal carcinoma

“…In patients dealing with locally advanced disease, the initial symptom is usually progressive dysphagia accompanied by noticeable weight loss 2. Pericarditis and pericardial effusion in patients with oesophageal carcinoma, while reported frequently in the literature, are usually secondary to the treatment of cancer and not an initial manifestation 3.…”