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A4130 - An Atypical Case of Cardiac Tamponade Leading to a Diagnosis of Metastatic Adenocarcinoma
Author Block: J. Trabanco1, Z. Burden1, N. Najjar2, W. Aung1; 1Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, United States, 2Pulmonary and Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL, United States.
Introduction:
Pericardial effusions are often found in any condition which affects the pericardium and at times due to some systemic diseases. These effusions can present as acute, sub-acute, or chronic, all of which can lead to cardiac tamponade. In a small percentage of these cases, pericardial effusions are found to be caused by malignancy. Our case deals with a patient who presented shortness of breath and chest pain caused by a pericardial effusion and sub-acute cardiac tamponade, however, later it would be revealed her condition was caused by an undiagnosed metastatic adenocarcinoma.
Case Description:
A 56 year old female presented to the emergency department with chest pain and shortness of breath that began when she awoke in the morning. She states she had never experienced these symptoms before. On admission, physical exam was notable for respiratory rate of 21, heart rate of 102 bpm, and muffled heart sounds but patient remained hemodynamically stable. A CT angiogram of the chest was performed for concerns of pulmonary embolism finding a moderate pericardial effusion, bilateral pleural effusions, several pulmonary masses, and bony metastasis. Initially shortness of breath was thought to be from the bilateral pleural effusion for which a diagnostic and therapeutic thoracentesis performed. Pleural fluid analysis showed a transudative effusion and cytology was negative for malignancy. An echocardiogram was then obtained which demonstrated a right atrial collapse and diastolic inflow variation with large pericardial effusion. Cardiothoracic surgery was emergently consulted and a pericardial window was placed with large amount of pericardial fluid removed and sent for cytology which later revealed newly diagnosed metastatic adenocarcinoma with lung primary.
Discussion:
When evaluating a patient with a new pericardial effusion or cardiac tamponade, it is important to consider malignancy in the initial differential when preparing to submit pericardial fluid for laboratory testing. Adenocarcinoma one of the most common types of lung malignancies accounting for 50% of lung neoplasms with the incidence of pericardial effusion secondary to malignancy accounting for 13-23 percent of all cases and 18 percent of undiagnosed neoplasms. This case illustrates the importance of considering malignancies and cardiac tamponade in patients presenting with seemingly benign symptoms such as shortness of breath.