Abusuliman Mohammed, Mohamed Amr M, Mahmoud Anas, Beilani Tala, Ismail-Sayed Ibrahim M
Internal Medicine, Henry Ford Health System, Detroit, USA.
Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, EGY.
Cureus. 2023 Sep 27;15(9):e46059. doi: 10.7759/cureus.46059. eCollection 2023 Sep.
Malignant pericardial effusion (MPE) is a slowly progressive and potentially clinically silent condition. Pericardial effusion can arise in oncology patients due to several factors, including disease spreading directly or metastatically, anticancer therapy side effects, or both. Solid and hematological malignancy metastasis more frequently involves the pericardium than primary tumors, with lung cancer being the most common metastatic tumor to involve the pericardium. While 5%-20% of all patients with metastatic neoplasms have pericardial involvement, MPE rarely appears with hemodynamic instability. Occasionally, MPE constitutes the initial manifestation of an underlying malignancy. Diagnosis and treatment require a multidisciplinary approach and a high degree of clinical suspicion. We present a case of a 59-year-old female with a history of peritoneal carcinoma who presented with persistent dyspnea on exertion following an episode of pneumonia that was treated with antibiotics. Physical examination and bedside point-of-care ultrasound (POCUS) revealed fluid in the pericardial sac. The cytological examination of the fluid revealed it to be of malignant origin, resulting from metastasis from gynecologic adenocarcinoma. Pericardiocentesis was done, and symptoms improved after fluid drainage.
恶性心包积液（MPE）是一种进展缓慢且临床上可能无症状的疾病。肿瘤患者出现心包积液可能有多种因素，包括疾病直接蔓延或转移、抗癌治疗的副作用，或两者皆有。实体瘤和血液系统恶性肿瘤转移比原发性肿瘤更常累及心包，其中肺癌是最常累及心包的转移性肿瘤。虽然所有转移性肿瘤患者中有5% - 20%有心包受累，但MPE很少伴有血流动力学不稳定。偶尔，MPE是潜在恶性肿瘤的初始表现。诊断和治疗需要多学科方法以及高度的临床怀疑。我们报告一例59岁女性，有腹膜癌病史，在因肺炎发作接受抗生素治疗后出现劳力性持续性呼吸困难。体格检查和床边即时超声（POCUS）显示心包腔内有液体。对液体进行细胞学检查发现其为恶性来源，是由妇科腺癌转移所致。进行了心包穿刺术，引流液体后症状改善。
