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• W4387248822 abstract "SESSION TITLE: Lung Cancer Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Lung cancer is the most common cause of death in the world and usually presents with an incidental lung nodule or respiratory symptoms. Cardiac tamponade is a rare presenting symptom of lung carcinoma and the chances of finding a neoplastic disease with initial presentation of pericardial effusion with cardiac tamponade is seen in only 2% of the patients[1]. CASE PRESENTATION: A 60 year old female presented to the hospital with dyspnea and chest pain since the last 2 weeks which intensified over the past few days. On arrival to the emergency department patient was in severe distress and was hypotensive with blood pressure of 94/60 and tachycardic with heart rate of 104 per minute. Physical examination was remarkable for pulsus paradoxus, raised jugular venous pressure with muffled heart sounds. Patient underwent x-ray chest which showed marked enlargement of the cardiomediastinal silhouette and upper mediastinal retrocardiac opacity, following which patient underwent computed tomography of the chest revealing large pericardial effusion measuring up to 4 cm in thickness and cardiac tamponade along with left upper lobe patchy mass and lytic Lesions in the manubrium and C7 concerning for metastases. Subsequently, echocardiography was done which showed a large circumferential pericardial effusion measuring more than 10 mm. She was transferred to the Critical Care Unit and underwent emergent pericardiocentesis with drainage of 1250 mL of serosanguinous pericardial fluid. A repeat Echo post drain insertion showed an improvement in fluid in the pericardial sac which correlated with clinical Improvement. Pericardial fluid cytology confirmed the diagnosis of metastatic non small cell lung carcinoma. DISCUSSION: Cardiac tamponade is an uncommon life threatening medical emergency when blood, fluid or pus accumulates between the myocardium and the pericardium, which prevent the cardiac ventricles from fully expanding in turn reducing the stroke volume and cardiac output. Hemorrhagic pericardial effusion as the de novo sign of malignancy is only 4 to 7%[2]. The pathogenesis of cardiac tamponade is due to obstruction of lymphatic and venous outflow from mediastinal lymph nodes to epicardial lymphatic plexus due to the tumor. Echocardiography is the diagnostic test of choice which shows enlarged pericardium with right ventricular diastolic collapse. A recurrence rate of nearly 40 % is found in patients who have underwent pericardiocentesis once, highlighting the importance of getting repeat ECHO done to prevent hemodynamic compromise from recurrence of large pericardial effusion. Treatment options include pericardiocentesis, pericardiectomy, creation of a pericardial window. Pericardiocentesis brings about immediate symptomatic relief in 90% of the patients and the fluid cytology is used for diagnosis of malignancy. In patients with malignant cardiac tamponade the 30-day mortality is 32.9%[2]. Optimal management of malignant cardiac tamponade from non small cell lung carcinoma includes intra-pericardial chemotherapy and sclerosis. Despite therapy the survival in such patience is dismal, at 3 months or less[3]. CONCLUSIONS: In patients presenting with cardiac tamponade and hemorrhagic pericardial effusion, a high index of suspicion should be kept in mind for an underlying malignancy .Identification of this unique presentation needs timely Intervention, as untreated tamponade is rapidly and universally fatal. REFERENCE #1: Joseph S, Al-Khalisy H, Randhawa U, Lazar J, Peroutka K. An unusual case of non-small-cell lung cancer presenting as spontaneous cardiac tamponade. J Community Support Oncol. 2016 Apr;14(4):169-72. doi: 10.12788/jcso.0188. PMID: 27152516. REFERENCE #2: Kumar A, Puttanna A. Recurrent cardiac tamponade: an initial presentation of lung adenocarcinoma. BMJ Case Rep. 2014 May 21;2014:bcr2013202553. doi: 10.1136/bcr-2013-202553. PMID: 24850550; PMCID: PMC4039852. REFERENCE #3: Li BT, Pearson A, Pavlakis N, Bell D, Lee A, Chan D, Harden M, Mathur M, Marshman D, Brady P, Clarke S. Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy. J Clin Med. 2014 Dec 30;4(1):75-84. doi: 10.3390/jcm4010075. PMID: 26237019; PMCID: PMC4470240. DISCLOSURES: No relevant relationships by Sanya Badar No relevant relationships by Ravleen Kaur No relevant relationships by Lavleen Kaur No relevant relationships by Sarasija Natarajan No relevant relationships by Syed Muhammad Hussain Zaidi" @default.
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• W4387248822 date "2023-10-01" @default.
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• W4387248822 title "HEMORRHAGIC CARDIAC TAMPONADE AS THE INITIAL MANIFESTATION OF NON-SMALL CELL LUNG CARCINOMA: AN UNDERSTUDIED ONCOLOGICAL EMERGENCY" @default.
• W4387248822 doi "https://doi.org/10.1016/j.chest.2023.07.2863" @default.
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