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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomonon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cadiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.
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PMID:Mechanism of electrical alternans in patients with pericardial effusion. 64 75

Cervical squamous cell carcinoma rarely metastasizes to the heart, and cardiac tamponade secondary to pericardial involvement has been only rarely reported. We describe a case of recurrent cervical squamous cells carcinoma presenting with cardiac tamponade secondary to extensive pericardial metastases. The patient, a 38-year old woman, initially presented with Stage IIIB cervical squamous cell carcinoma. She responded well to radiation and chemotherapy, there was no clinical or radiographic evidence of persistent disease after the initial therapy. Sixteen months after presentation, she developed shortness of breath and chest pain. The patient received additional chemotherapy; however, she died 17 months after her initial presentation. At autopsy, metastatic keratinizing squamous cell carcinoma extensively involved the pericardium and superficial myocardium. This case illustrates the unusual occurrence of recurrent cervical squamous carcinoma presenting with cardiac dysfunction secondary to pericardial metastases.
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PMID:Recurrent cervical squamous cell carcinoma presenting with cardiac tamponade. Recurrent cervical carcinoma-tamponade. 883 61

A 50-year-old female was admitted because of nausea, vomiting, and cerebellar ataxia. Computed tomography scan revealed an enhanced mass accompanied with a cyst in the right cerebellar hemisphere. The mass situated in the subcortical region was removed. Histologically, highly vascular tumor cells lined the cavities. Postoperative radio- and chemotherapy were administered and the clinical symptoms improved gradually. Two months later, the patient complained of dyspnea. Chest X-ray on second admission demonstrated cardiomegaly. Hemorrhagic pericardial effusion amounting to 1000 ml was aspirated by pericardial puncture. Papillary clusters of tumor cells were demonstrated in the pericardial effusion. The patient died of cardiac failure. At necropsy solid tumors were located in the heart, lung, left inguinal region, and cerebellum. Histological diagnosis was mesothelioma arising from the heart. Primary pericardial mesotheliomas are rare; approximately 106 cases have been reported. Pericardial mesothelioma frequently spreads to the adjacent pleura and mediastinum, but distant metastases are extremely rare because patients with pericardial mesothelioma tend to die early due to cardiac failure or cardiac tamponade.
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PMID:[Brain metastasis from primary pericardial mesothelioma. Case report]. 170 70

Echocardiography and Doppler ultrasound are useful in evaluating a variety of pathological conditions affecting the pericardium. Cardiac tamponade results in right atrial collapse and right ventricular diastolic collapse detectable by echocardiography. These echocardiographic signs have a high degree of sensitivity and specificity. False-negative echocardiographic studies may be seen in patients with pulmonary hypertension, and false-positive studies for cardiac tamponade may occur in severe hypovolemia. Although cardiac tamponade is usually caused by pericardial effusion, less commonly intrapericardial clot may result in hemodynamic compromise. Pericardial clot may be echogenic, and hence the diagnosis potentially can be missed. If the intrapericardial clot is localized, the classic echocardiographic signs of pericardial effusion may be absent, and a localized mass may be seen on the echocardiogram. Increased respiratory variation in transvalvular blood flow velocities detectable by Doppler ultrasound is found in cardiac tamponade. Doppler ultrasound studies may be particularly useful in those patients in whom the characteristic echocardiographic abnormalities are absent. Both M-mode and two-dimensional echocardiography may be useful in diagnosing pericardial thickening. Constrictive pericarditis results in a variety of echocardiographic abnormalities including pericardial thickening; biatrial enlargement with good left ventricular function; a diastolic septal bounce; and a dilated inferior vena cava without significant respiratory variation. Doppler echocardiographic abnormalities are commonly found in constrictive pericarditis. Echocardiography is also useful as a guide to performing pericardiocentesis and in the detection of pericardial adhesions and pericardial metastases.
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PMID:Echocardiography and Doppler ultrasound in the evaluation of pericardial disease. 188

The spread of metastatic cancer to the pericardium is the most common cause of cardiac tamponade in medical inpatient settings. Lung cancer, breast cancer, and the hematologic malignancies account for some three quarters of the cases. Occasionally, usually in lung cancer, the pericardial involvement is the first clinical presentation of the neoplastic disease. Differential diagnosis includes radiation pericarditis and cardiac toxicity from chemotherapeutic drugs, as well as any of the causes of pericardial disease in patients without neoplasm. Idiopathic nonneoplastic, noninflammatory pericardial effusion is surprisingly common in cancer patients. The initial cardiac tamponade may be managed with either needle tap or subxiphoid pericardiostomy. Pericardiocentesis, performed with echocardiographic guidance and followed by percutaneous catheter drainage for several days, is safe and effective in neoplastic pericardial effusion. It may be the only local therapy that is needed. Further local treatment, for those patients who develop recurrent cardiac tamponade after an initial drainage procedure, may include tetracycline sclerosis of the pericardial space, instillation of cancer chemotherapeutic agents, radiation therapy, and pericardiectomy. No controlled clinical trials of these methods of treatment are available. The choice of therapy is based on various considerations in individual patients, particularly the patient's general condition and the likelihood of a long-term response to treatment of the systemic neoplastic disease.
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PMID:Neoplastic pericardial disease. 224 21

Pericardial exudate and/or spread of the tumour to the pericardium occurs frequently in leukaemia and malignant lymphomata. Metastases to the pericardium may be demonstrated at autopsy in 50% and 20-25%, respectively. In the majority of cases no symptoms from the heart occur. In cases with significant pericardial effusion or constrictive pericarditis, urgent treatment is indicated. Pericardiocentesis is carried out in cases of cardiac tamponade. Irradiation has frequently a rapid and dramatic effect in cases of massive tumour infiltration in the pericardium. Long-term treatment depends on the malignant haematological disease concerned. Meticulous diagnostic investigation is therefore indicated in every case with cardiac symptoms. This has frequently therapeutic consequences, reduces the morbidity and prolongs survival. Two cases of acute pericardial effusion with haemodynamic consequences are reviewed in this article. The haematological diagnoses were acute myeloid leukaemia and malignant lymphoma (diffuse large-cell non-Hodgkin's lymphoma), respectively.
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PMID:[Pericardial involvement in leukemia and malignant lymphoma]. 240 59

Between 1979 and 1985, seven patients (five children and two adults) were treated for primary cardiac tumours other than benign atrial myxomas. There were five malignant neoplasms (two non-classifiable sarcomas, one haemangiosarcoma, one histiocytoma and one neurofibrosarcoma) and two benign tumours (fibromas). Echocardiography, cardiac catheterisation, computed tomography and magnetic resonance imaging provided diagnostic confirmation. The two patients with fibroma are alive and well 4 and 5 years after radical resection of the tumours from the interventricular septum. The patient with a neurofibrosarcoma underwent orthotopic cardiac transplantation and is well 5.5 years postoperatively with no evidence of residual disease or recurrence. One patient died awaiting a donor heart for transplantation. Another patient who was a candidate for heart and lung transplantation was found to have an unresectable tumour at the time of operation. One patient with sarcoma who underwent a successful emergency partial resection for relief of cardiac tamponade died 18 months later from widespread metastases. The seventh patient was inoperable due to multiple secondaries. It is concluded that radical resection of large, benign, cardiac tumours can give good results and that early cardiac transplantation probably offers the only hope for patients with malignant tumours of the heart.
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PMID:Primary cardiac tumours--is there a place for cardiac transplantation? 263 39

Metastatic pericarditis was identified in 74 out of 240 cancer patients suffering from secondary tumor lesions in the heart (30.8%). It involved quick accumulation of exudate which led to grave heart failure due to cardiac tamponade development in 39%. Liquid in the heart sac was detected by X-rays in 20, ECG-39, and echocardiography--in 83% of patients. Application of echocardiography provides a means for ascertaining the extent of pericardial involvement and monitoring changes in tumor process occurring in the course of therapy.
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PMID:[Clinical aspects and diagnosis of metastatic pericarditis in cancer patients]. 394 87

An exudative pericarditis was the only sign of an adenocarcinoma arising from the right main bronchus of the lung for two and a half months. No metastases were found at the time of diagnosis. Pericarditis relapsed quickly after repeated pericardiocenteses, and systemic chemotherapy did not influence its course. Cardiac tamponade caused the death of the patient.
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PMID:Severe pericarditis as a presenting sign of bronchogenic carcinoma. 398 50

The clinicopathologic features of a case of cardiac tamponade as the initial presentation of extracardiac malignancy is reported and compared with those of previously reported cases. The lung was the site of the primary tumor in 58% of the cases. Irrespective of the sites of the primary tumor, mediastinal involvement or intrapulmonary metastases or both were documented in 88% of the cases. Examinations of the pericardial fluid and pericardiectomy specimen were negative in a considerable number of cases. Therefore, careful examination of the mediastinum and the accessible lung tissue at the time of pericardiectomy may reveal the malignant nature of the disease which may otherwise remain undiagnosed.
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PMID:Extracardiac malignancy presenting with cardiac tamponade. 634 34


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