Pericardial Metastasis Induced Tamponade from Urothelial Carcinoma: A Rare Entity

Abstract

Urothelial carcinoma in a few cases may result in cardiac metastasis. A rare presentation of this condition is its diagnosis as a result of cardiac tamponade. Tamponade is an unusual entity as a result of urothelial carcinoma and has only been reported in four cases. There have also been only a total of fifteen cases of cardiac metastasis from this form of malignancy. It is through this discussion that we emphasize the importance of early detection and monitoring of cardiac symptoms with the implementation of echocardiogram imaging. Although not feasible in all patients it may be considered in those presenting with cardiac and pulmonary symptoms. In this case we discuss the presentation of a 71-year-old gentleman with a history of urothelial carcinoma after cystectomy and while on chemotherapy presented with new onset atrial fibrillation and later was diagnosed with cardiac tamponade as a result of malignant metastasis.

Rare presentation of urothelial bladder carcinoma as cardiac tamponade

“…In most of these cases, there was a visible metastatic lesion within the heart. 3 , 4 In our case, there was no cardiac lesion seen. What eventually caused our patient's demise was respiratory compromise due to lymphangitis carcinomatosis from the bladder.…”

“…There have been 3 documented cases of urothelial carcinoma presenting as cardiac tamponade with positive cytology. 1 , 2 , 3 We will discuss a case in which pericardial effusion with tamponade was the initial presentation of the patient's transitional cell carcinoma of the bladder.…”

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

“…To the best of our knowledge after a review of the literature, there have been only five cases of cardiac tamponade due to metastatic UC, with our case being the sixth [ 6 – 10 ]. In four of these cases, patients presented with symptoms of dyspnea, cough, fatigue, orthopnea, and chest pain [ 7 – 10 ].…”

“…Pericardiocentesis was performed for drainage and sent for cytology in all cases. However, in three of the cases, the pericardial fluid cytodiagnosis was equivocal and a pericardial biopsy was also obtained which led to the diagnosis of metastasis from UC [ 6 , 8 , 10 ]. In one case, the cytology was negative and no pericardial biopsy was performed; however, a large echogenic mass abutting the proximal free wall of the left ventricle and extending into the base of the pericardial cavity was noted [ 9 ].…”

Multiple cardiac metastases from urothelial carcinoma case report

“…However, cardiac-specific symptoms may occur depending on the site of the metastatic lesions. Patients with pericardial metastasis may present with a pericarditis-like picture, including the development of a pericardial effusion and possibly tamponade [ 7 , 9 , 15 ]. Myocardial involvement may result in arrhythmic complications including life-threatening ventricular fibrillation or complete atrioventricular block [ 6 , 16 , 17 ].…”