Cardiac tamponade. Presentation of two cases and review of the literature

Abstract

Objective: Describe two patients, who presented with cardiac tamponade attributable to malignancies and a review of the literature relative to clinical presentation. Methods: We present clinical and imaging data for the two patients Results: The two cases presented at the Accident and Emergency Department of our institution. The first case was a 48 year old male patient who was under investigation for a mediastinal mass, and the second, a 47 year old male patient who had been previously diagnosed with mesothelioma. Echocardiography showed in the two cases large pericardial effusion and diastolic right ventricular collapse. Emergency pericardiocentesis was performed on the two patients. The first patient was mechanically ventilated almost immediately after the procedure, and died 72 hours after admission as a consequence of sepsis. On the postmortem examination, large cell carcinoma of the lung with metastases to the trachea and brain was confirmed. The second case had a successful recovery and was
discharged to be followed up as an out-patient. Conclusion: Cardiac tamponade is not an unusual presentation in late stage malignancies and the role of echocardiography is primordial for the diagnosis, treatment and follow up of these patients. A high
index of suspicion must be maintained for timely diagnosis of cardiac tamponade followed by prompt intervention.