title: Cardiac tamponade caused by primary lung cancer and the management of pericardial effusion.
abstract: METHODS
  Between 1978 and 1990, 51 cases of pericardial effusion secondary to lung cancer were treated at the National Cancer Center Hospital by creating a pericardial window, using the subxiphoid approach, that was connected to a water-sealed drainage system.
  
  
  RESULTS
  Most patients had advanced disease, such as distant metastasis (76%), pleural effusion (88%), and clinical Stage N2 or N3 disease (98%). Forty-five patients had cardiac tamponade, and six had no symptoms attributable to pericardial effusion. Cardiac tamponade was the initial manifestation of lung cancer in only 3 patients; it was a late manifestation in 48. Of those specimens that were examined cytologically, 92% had positive findings. The interval from creation of the pericardial window until removal of the drainage tube ranged from 4-135 days (median, 11 days). The interval was significantly longer in patients who previously had received thoracic radiation therapy (P < 0.05). The overall median survival was 80 days, and the 1-year survival rate was 10.5%. Postmortem examination showed that constrictive heart failure caused by pericardial lesions was the major contributory cause of death in 32% of patients. Using multivariate analysis, factors indicating a poor prognosis were: (1) the interval from the diagnosis of lung cancer to pericardial effusion development (P = 0.005) and (2) the absence of prior surgery (P = 0.007).
  
  
  CONCLUSIONS
  The creation of a pericardial window effectively treated pericardial effusion in 85% of cases. However, the role of intrapericardial instillation of anticancer or sclerosing agents was unclear in this retrospective analysis.
authors.affiliation: Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Okamoto
authors.forename: T
authors.initials: T
authors.lastname: Shinkai
authors.forename: M
authors.initials: M
authors.lastname: Yamakido
authors.forename: N
authors.initials: N
authors.lastname: Saijo
mesh_terms: D000328:Adult; D000368:Aged; D002305:Cardiac Tamponade / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D004322:Drainage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010490:Pericardial Effusion / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010491:Pericardial Window Techniques / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies