Soofi Muhammad Adil, Youssef Mostafa Adel
Department of Cardiology, Prince Salman Heart Centre, Kind Fahad Medical City, Riyadh, Saudi Arabia.
J Coll Physicians Surg Pak. 2014 Mar;24 Suppl 1:S5-7.
Cardiac tamponade is an unusual earliest presentation of undiagnosed metastatic adenocarcinoma of unknown origin. Malignant pericardial effusion requiring drainage is also a poor prognostic marker with reported median survival of 6.1 months. A choroidal mass may be the presenting sign of systemic malignancy; the diagnosis of metastatic ocular tumour is important as it portends poor prognosis. We are reporting an unusual presentation of an undiagnosed metastatic adenocarcinoma presenting in an elderly male primarily with loss of vision due to choroidal mass causing retinal detachment and repeated episodes of dyspnea due to recurrent pericardial effusion causing cardiac tamponade. Fluid analysis from pleura and breast biopsy revealed evidence of metastatic adenocarcinoma. Immunohistochemistry finding were suggestive of possible lung or gastrointestinal tract as a primary source. Imaging studies showed widely spread malignancy involving abdominal viscera, mediastinum, lung, pericardium, choroid and brain. He showed features of pericardial constriction on echocardiography after fluid drainage due to pericardial infiltration. He expired before he could have received palliative chemotherapy.
心脏压塞是未确诊的不明原发转移性腺癌极为罕见的早期表现。需要引流的恶性心包积液也是预后不良的标志，报道的中位生存期为6.1个月。脉络膜肿物可能是全身恶性肿瘤的首发体征；转移性眼肿瘤的诊断很重要，因为其预示着预后不良。我们报告了一例未确诊的转移性腺癌的不寻常表现，该病例发生在一名老年男性身上，主要表现为因脉络膜肿物导致视网膜脱离而失明，以及因复发性心包积液导致心脏压塞而反复出现呼吸困难。胸膜液分析和乳腺活检显示有转移性腺癌的证据。免疫组化结果提示可能的原发部位为肺或胃肠道。影像学研究显示恶性肿瘤广泛扩散，累及腹部脏器、纵隔、肺、心包、脉络膜和脑。由于心包浸润，引流积液后超声心动图显示他有缩窄性心包炎的特征。他在接受姑息化疗之前就去世了。
