Gowda Ramesh M, Khan Ijaz A, Mehta Nirav J, Gowda Mamatha R, Hyde Phyllis, Vasavada Balendu C, Sacchi Terrence J
Department of Medicine, Long Island College Hospital, Brooklyn, NY, USA.
Angiology. 2004 Nov-Dec;55(6):691-5. doi: 10.1177/00033197040550i611.
A combination of pericardial effusion with cardiac tamponade and superior vena caval syndrome is an unusual first presentation of carcinoma of lung, although cardiac involvement is often a late finding in widespread malignancy. Clinical identification can be difficult antemortem. Accurate diagnosis and prompt intervention are necessary to prevent adverse outcomes. Decisions regarding treatment must take into account the clinical presentation and echocardiographic findings. Echocardiography-guided pericardiocentesis with catheter drainage and/or pericardial window is the primary treatment strategy of choice for most large or hemodynamically significant effusions. New cardiac symptoms or classic findings of cardiac tamponade should prompt aggressive investigation. We present a case of adenocarcinoma of the lung that initially presented as pericardial effusion with tamponade and superior vena cava syndrome. The patient had all the clinical features of tamponade such as pulsus paradoxus, tachycardia, elevated jugular venous pressure, hypotension, and electrical alternans on surface electrocardiography. The findings were confirmed on echocardiography and computed tomography of chest, both of which allowed for rapid confirmation of the presence of an effusion and compression of the superior vena cava. The existing literature on the subject is succinctly reviewed.
心包积液合并心脏压塞及上腔静脉综合征作为肺癌的首发表现较为罕见，尽管心脏受累在广泛转移的恶性肿瘤中通常是晚期表现。生前临床诊断可能困难。准确诊断和及时干预对于预防不良后果很有必要。治疗决策必须考虑临床表现和超声心动图检查结果。对于大多数大量或具有血流动力学意义的积液，超声心动图引导下的心包穿刺置管引流和/或心包开窗术是主要的治疗选择策略。新出现的心脏症状或心脏压塞的典型表现应促使进行积极检查。我们报告一例肺癌腺癌患者，最初表现为心包积液合并心脏压塞及上腔静脉综合征。患者具有心脏压塞的所有临床特征，如奇脉、心动过速、颈静脉压升高、低血压以及体表心电图上的电交替现象。超声心动图和胸部计算机断层扫描结果证实了这些表现，二者均能快速确认积液的存在以及上腔静脉受压情况。本文对该主题的现有文献进行了简要综述。
