CARDIAC-TAMPONADE AS THE INITIAL PRESENTATION OF MALIGNANCY - IS IT AS RARE AS PREVIOUSLY SUPPOSED

Advanced malignant disease frequently involves the heart and pericardi um, and pericardial effusion is a common postmortem finding in such pa tients. Identification of pericardial effusions in life is uncommon, h owever, even when symptomatic. Cardiac tamponade occurring as the firs t presentation of malignancy appears to be uncommon. We present five c ases of cardiac tamponade due to undiagnosed malignancy which presente d to a general medical unit over 18 months. The availability of echoca rdiography was an important factor in correct diagnosis, since clinica l features were non-specific. Bronchial adenocarcinoma was the cause i n three of the five cases. Review of the literature confirms adenocarc inomas of the bronchus as the most common cause of this complication. The majority of cases have presented with large volume, haemorrhagic e ffusions, and cytology (with or without carcinoembryonic antigen measu rement) was diagnostic in most patients. Immediate treatment with subx iphoid pericardiotomy is recommended; the role of balloon catheter per icardiotomy remains to be established. Combined chemotherapy and radio therapy appears to extend survival, which in some cases may be prolong ed. We recommend that early echocardiography should be obtained in all patients presenting with apparent cardiac failure, since early treatm ent of malignant effusions provides symptomatic relief.