Malignant pleural/pericardial effusion with tamponade and life-threatening reversible myocardial depression in a case of an initial presentation of lung adenocarcinoma.
We present a case of a middle-aged woman in cardiac tamponade. Following pericardiocentesis that removed 1,500 ml of hemorrhagic fluid, the patient exhibited cardiogenic shock; LVEF, at its nadir, on inotrope, was less than 20%. Ventricular function slowly improved, with inotropic support, to the normal range by the 25th day of hospitalization. Cardiac failure in malignancy has often been attributed to multi-system failure; this case showed a hereto unrecognized clinical phenomenon - 'malignancy-associated myopericarditis'. While the direct link of cause and effect cannot be made with certainty, the case should be instructive to other clinicians who encounter similar life-threatening presentations of cardiac decompensation in malignancy.
Ma
Tony S
TS
Section of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. tma@bcm.tmc.edu
Hayes
Teresa G
TG
Levine
Glenn N
GN
Carabello
Blase A
BA
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000503:physiopathology; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000503:physiopathology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000503:physiopathology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology