Malignant pericardial effusion

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.

• Intervalinterval development of nodular thickening of the pericardium and mild pericardial effusion.
• Intervalinterval 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.  
• Intervalinterval development of multilevel enlarged soft tissue density mediastinal lymph nodes. 
• Statusstatus post right mastectomy and right axillary clearance.
• Mildmild reticulation/fibrosis in the apical and subpleural anterior segments of the right upper lobe likely related to the previous radiotherapy. 
• Mildlymildly enlarged liver with generalized decreased parenchymal density without any obvious focal lesion, likely related to the previous chemotherapy/hormonal therapy with tamoxifen.

• The case demonstrates typical findings of malignant pericardial disease. 

  Two months later, the patient presented with worsening symptoms. 

• Echocardiogram

  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.