Malignant pericardial effusion

Case contributed by Dr Ammar Ashraf

Presentation

Worsening shortness of breath and chest pain. No history of fever, or cough. History of treatment of metastatic carcinoma right breast two years ago.

Patient Data

Age: 50 years
Gender: Female
CT

Baseline CT chest two years ago

Lobulated right breast mass with enlarged regional axillary lymph nodes in keeping with primary breast cancer. Enlarged left hilar lymph nodes and multiple small hepatic lesions, suggestive of metastases. No pulmonary or osseous metastases are seen.

CT

Current CT chest

  • interval development of nodular thickening of the pericardium and mild pericardial effusion
  • interval enlargement of the left hilar lymphadenopathy, which is now encasing the left pulmonary artery and left upper lobe bronchus, leading to a partial collapse of the left upper lobe
  • interval development of multilevel enlarged soft tissue density mediastinal lymph nodes
  • status post right mastectomy and right axillary clearance
  • mild reticulation/fibrosis in the apical and subpleural anterior segments of the right upper lobe likely related to the previous radiotherapy
  • mildly enlarged liver with generalized decreased parenchymal density without any obvious focal lesion, likely related to the previous chemotherapy/hormonal therapy with tamoxifen

Case Discussion

The case demonstrates typical findings of malignant pericardial disease

Two months later, the patient presented with worsening symptoms. 

An echocardiogram showed moderate pericardial effusion (cardiac tamponade). 1200 ml of dark brown/hemorrhagic pericardial fluid was aspirated.

Cytological evaluation of the pericardial fluid showed clusters of malignant cells, suggestive of metastatic carcinoma of breast origin.

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Case information

rID: 80969
Published: 11th Aug 2020
Last edited: 1st Mar 2021
System: Oncology, Cardiac
Inclusion in quiz mode: Included
Institution: Ministry of national guard health affairs

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