Hemorrhagic Pericardial Effusion Leading to Cardiac Tamponade: A Rare Initial Presentation of Adenocarcinoma of the Lung

Abstract

Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-year-old female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion, left upper lobe mass, possible lymphangitic spread of carcinoma in the left lung, and adenopathy in the mediastinum. The echocardiography findings further confirmed tamponade. Cardiology and pulmonary medicine were taken on board for a possible malignancy associated pleural effusion leading to cardiac tamponade. Pericardial fluid analysis showed atypical cells suggestive of malignancy. Transbronchial biopsy confirmed moderately differentiated invasive adenocarcinoma. Positron emission tomography (PET) scan revealed metastatic spread to the mediastinum and right hilum with possible pleural metastatic disease seen posteriorly in the left hemithorax. The patient was discharged home with oncology follow up for chemotherapy.

A Case of Primary Lung Adenocarcinoma With Two Uncommon Presentations: Neurological Paraneoplastic Syndrome and Pericardial Effusion

“…All of these alternative diagnoses were ruled out, with lung cancer emerging as the most likely cause. We must note that hemorrhagic pericardial effusion accompanied by tamponade is a sign of an undiagnosed and advanced malignancy with a poor prognosis [3][4][5]13,14].…”

Cardiac tamponade as the first presentation of thymoma: A case report during COVID-19 pandemic

“…6 28-day mortality in patients with malignant cardiac tamponade is 33% with mean survival around 144 days. 7 The overall incidence of thymomas is rare with only 0.15 cases per 100,000 being identified, and pericardial tamponade is a rare initial manifestation of thymoma. 8…”

“…6 28-day mortality in patients with malignant cardiac tamponade is 33% with mean survival around 144 days. 7 The overall incidence of thymomas is rare with only 0.15 cases per 100,000 being identified, and pericardial tamponade is a rare initial manifestation of thymoma. 8 The pathophysiology of the neoplastic pericardial disease is thought to be predominantly through regional lymphatic invasion as described in Fraser hypothesis.…”

Large Hemorrhagic Pericardial Effusion and Cardiac Tamponade Following BNT162b2 (BioNTech/Pfizer) Vaccine

“…7 Mehmood et al describe a case of hemorrhagic pericardial effusion leading to cardiac tamponade as the initial presentation of lung cancer. 12 Pericarditis associated mRNA vaccinations may be linked to immunogenic, autoimmune, and hormonal pathways. Despite nucleoside modifications in mRNA vaccine development, immune response to mRNA may induce an anomalous innate and acquired immune response, triggering cardiac pro-inflammatory cascades and dysregulated cytokine proliferation.…”