title: Pericardial biopsy revealed gastric signet-ring cell cancer.
abstract: We describe the case of an 85-year-old man who presented with a large pericardial effusion. The patient was admitted because of anorexia and general malaise. Chest X-ray revealed an increased cardiothoracic ratio and a small amount of bilateral pleural effusion. Two-dimensional ultrasonographic echocardiography showed pericardial effusions with atrial and right ventricular early diastolic collapse, establishing the diagnosis of cardiac tamponade. Signet-ring cell cancer with pericardial involvement was diagnosed by subxiphoid pericardiostomy. The clear fluid was removed through pericardial drainage. The signet-ring cell carcinoma of the stomach was revealed by gastric fiberscope examination after pericardial biopsy proved malignancy. Virchow lymph node metastasis was also found. We diagnosed the patient with gastric cancer stage IV and suggested him the best supportive therapy. He died of cardiac arrest 1 month after best supportive care.
authors.affiliation: Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Iwata
authors.affiliation: Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Ryusho
authors.initials: R
authors.lastname: Sangen
authors.affiliation: Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Usuda
authors.affiliation: Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Tsugiyasu
authors.initials: T
authors.lastname: Kanda
authors.affiliation: Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Shou
authors.initials: S
authors.lastname: Takagi
authors.affiliation: Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sakamoto
keywords: Cardiac tamponade; Gastric signet-ring cell carcinoma; Pericardiostomy