Pericarditis in malignancy: Difference between revisions
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Gaurded prognosis associated with malignancies is worsened by [[pericardial effusion]] and [[cardiac tamponade]]. Children may have poor prognosis and thus, prompt detection and treatment of cardiac tamponade improves survival<ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid16719168">{{cite journal| author=Bień E, Stefanowicz J, Aleszewicz-Baranowska J, Połczyńska K, Szołkiewicz A, Stachowicz-Stencel T et al.| title=[Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]. | journal=Med Wieku Rozwoj | year= 2005 | volume= 9 | issue= 3 Pt 2 | pages= 551-9 | pmid=16719168 | doi= | pmc= | url= }} </ref>. | Gaurded prognosis associated with malignancies is worsened by [[pericardial effusion]] and [[cardiac tamponade]]. Children may have poor prognosis and thus, prompt detection and treatment of cardiac tamponade improves survival<ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid16719168">{{cite journal| author=Bień E, Stefanowicz J, Aleszewicz-Baranowska J, Połczyńska K, Szołkiewicz A, Stachowicz-Stencel T et al.| title=[Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]. | journal=Med Wieku Rozwoj | year= 2005 | volume= 9 | issue= 3 Pt 2 | pages= 551-9 | pmid=16719168 | doi= | pmc= | url= }} </ref>. | ||
Patients rarely present with cardiac tamponade as their first presentation. [[Superior venacava syndrome]] may occur in few secondary to either coexisting tumor or rapid accumulation of pericardial effusion<ref name="pmid19956024">{{cite journal| author=Tsai MH, Yang CP, Chung HT, Shih LY| title=Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. | journal=J Pediatr Hematol Oncol | year= 2009 | volume= 31 | issue= 12 | pages= 980-2 | pmid=19956024 | doi=10.1097/MPH.0b013e3181b86ff3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19956024 }} </ref>. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Pericardium may be involved by direct local spread from neoplasms such as [[breast carcinoma|breast]] and [[lung carcinoma]]s or by metastatic spread via blood stream and lymphatics as in [[melanomas]], [[lymphomas]] and [[leukemias]]. | Pericardium may be involved by direct local spread from neoplasms such as [[breast carcinoma|breast]] and [[lung carcinoma]]s or by metastatic spread via blood stream and lymphatics as in [[melanomas]], [[lymphomas]] and [[leukemias]]. | ||
[[Pericardial effusion]] in such situations may occur either secondary to pericardial inflammation or obstruction of lymphatic drainage by enlarged [[mediastinal nodes]]<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056 }} </ref><ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid15904655">{{cite journal| author=Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E et al.| title=Relation of acute pericardial disease to malignancy. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 11 | pages= 1393-4 | pmid=15904655 | doi=10.1016/j.amjcard.2005.01.094 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15904655 }} </ref> | [[Pericardial effusion]] in such situations may occur either secondary to pericardial inflammation or obstruction of lymphatic drainage by enlarged [[mediastinal nodes]]<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056 }} </ref><ref name="pmid16523053">{{cite journal| author=Ben-Horin S, Bank I, Guetta V, Livneh A| title=Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. | journal=Medicine (Baltimore) | year= 2006 | volume= 85 | issue= 1 | pages= 49-53 | pmid=16523053 | doi=10.1097/01.md.0000199556.69588.8e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16523053 }} </ref><ref name="pmid15904655">{{cite journal| author=Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E et al.| title=Relation of acute pericardial disease to malignancy. | journal=Am J Cardiol | year= 2005 | volume= 95 | issue= 11 | pages= 1393-4 | pmid=15904655 | doi=10.1016/j.amjcard.2005.01.094 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15904655 }} </ref>. | ||
==Diagnosis== | |||
===History and symptoms=== | |||
In addition to malignancy specific presentation, patients may present with the following symptoms due to pericardial involvement: | |||
*[[Fever]] | |||
*[[Chest pain]] that improves on leaning forward and worsens on inspiration | |||
*[[Breathlessness]] | |||
*[[Orthopnoea]] | |||
*[[Dizziness]] | |||
*[[Palpitation]] | |||
*[[Malaise]] | |||
*[[Ankle edema]] | |||
Many patients may be asymptomatic and pericardial involvement may be detected incidentally on chest x-ray or on [[autopsy]]. | |||
==References== | ==References== | ||
Revision as of 16:24, 5 July 2011
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Risk calculators and risk factors for Pericarditis in malignancy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Many malignant neoplasms such as lung cancer, breast cancer, esophageal cancer, lymphomas, melanomas, kaposi's sarcoma and leukemias may metastasize to pericardium causing pericarditis, effusion, cardiac tamponade and pericardial constriction. Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy[1][2]. Among patients presenting with pericarditis or pericardial effusion with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%[3][4][5].
Malignancy related pericardial disease can manifest as pericarditis, pericardial effusion, cardiac tamponade or pericardial constriction.
Epidemiology and demographics
In developed countries malignancy is the leading cause of cardiac tamponade secondary to pericardial effusion. Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy[1][2]. Among patients presenting with pericarditis or pericardial effusion with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%[3][4][5].
Carcinoma of the lung is the most common cause for pericardial effusion in malignancy accounting for approximately 40%. Another 40% of cases could be due to breast carcinoma and lymphomas. Carcinoma of GI tract, melanoma, sarcomas, and other neoplastic diseases are less common.
Kaposi sarcoma and lymphomas associated with HIV were other neoplastic causes of pericardial effusion which accounted for 5% and 7% respectively[6] in one study and 15% together[7] in another series. However, with the use of antiretroviral agents, the incidence of Kaposi carcinoma and subsequent pericardial effusion has considerably decreased.
In regions where tuberculosis is not highly prevalent, malignancy may be the most common cause of a hemorrhagic effusion[8][9]
Sex
Higher incidence of the pericardial effusion related to malignancy is observed among males with ratio of 7:3 as reported in a series[10]
Natural history, prognosis and complications
Gaurded prognosis associated with malignancies is worsened by pericardial effusion and cardiac tamponade. Children may have poor prognosis and thus, prompt detection and treatment of cardiac tamponade improves survival[11][12].
Patients rarely present with cardiac tamponade as their first presentation. Superior venacava syndrome may occur in few secondary to either coexisting tumor or rapid accumulation of pericardial effusion[13].
Pathophysiology
Pericardium may be involved by direct local spread from neoplasms such as breast and lung carcinomas or by metastatic spread via blood stream and lymphatics as in melanomas, lymphomas and leukemias.
Pericardial effusion in such situations may occur either secondary to pericardial inflammation or obstruction of lymphatic drainage by enlarged mediastinal nodes[14][11][5].
Diagnosis
History and symptoms
In addition to malignancy specific presentation, patients may present with the following symptoms due to pericardial involvement:
- Fever
- Chest pain that improves on leaning forward and worsens on inspiration
- Breathlessness
- Orthopnoea
- Dizziness
- Palpitation
- Malaise
- Ankle edema
Many patients may be asymptomatic and pericardial involvement may be detected incidentally on chest x-ray or on autopsy.
References
- ↑ 1.0 1.1 Gornik HL, Gerhard-Herman M, Beckman JA (2005). "Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion". J Clin Oncol. 23 (22): 5211–6. doi:10.1200/JCO.2005.00.745. PMID 16051963.
- ↑ 2.0 2.1 Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
- ↑ 3.0 3.1 Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J (1985). "Primary acute pericardial disease: a prospective series of 231 consecutive patients". Am J Cardiol. 56 (10): 623–30. PMID 4050698.
- ↑ 4.0 4.1 Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A; et al. (2007). "Indicators of poor prognosis of acute pericarditis". Circulation. 115 (21): 2739–44. doi:10.1161/CIRCULATIONAHA.106.662114. PMID 17502574.
- ↑ 5.0 5.1 5.2 Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E; et al. (2005). "Relation of acute pericardial disease to malignancy". Am J Cardiol. 95 (11): 1393–4. doi:10.1016/j.amjcard.2005.01.094. PMID 15904655.
- ↑ Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999). "Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature". Am Heart J. 137 (3): 516–21. PMID 10047635.
- ↑ Gowda RM, Khan IA, Mehta NJ, Gowda MR, Sacchi TJ, Vasavada BC (2003). "Cardiac tamponade in patients with human immunodeficiency virus disease". Angiology. 54 (4): 469–74. PMID 12934767.
- ↑ Maisch B, Ristic A, Pankuweit S (2010). "Evaluation and management of pericardial effusion in patients with neoplastic disease". Prog Cardiovasc Dis. 53 (2): 157–63. doi:10.1016/j.pcad.2010.06.003. PMID 20728703.
- ↑ Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
- ↑ Medary I, Steinherz LJ, Aronson DC, La Quaglia MP (1996). "Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage". J Pediatr Surg. 31 (1): 197–9, discussion 199-200. PMID 8632279.
- ↑ 11.0 11.1 Ben-Horin S, Bank I, Guetta V, Livneh A (2006). "Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis". Medicine (Baltimore). 85 (1): 49–53. doi:10.1097/01.md.0000199556.69588.8e. PMID 16523053.
- ↑ Bień E, Stefanowicz J, Aleszewicz-Baranowska J, Połczyńska K, Szołkiewicz A, Stachowicz-Stencel T; et al. (2005). "[Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]". Med Wieku Rozwoj. 9 (3 Pt 2): 551–9. PMID 16719168.
- ↑ Tsai MH, Yang CP, Chung HT, Shih LY (2009). "Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome". J Pediatr Hematol Oncol. 31 (12): 980–2. doi:10.1097/MPH.0b013e3181b86ff3. PMID 19956024.
- ↑ Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.