Tumor of pericardium is a rare and insufficiently explored area in clinical oncology. Pericardial tumor cases are complexified with a variety of clinical patterns, difficulties in diagnosis and absence of apparent symptoms of pathology.The estimated frequency of pericardial tumor ranges from 0,0017% to 0,02%.
Not obvious and Pericarditis and latent Heart Failure Respiratory, Nerve trunk, Bronchial tubes, Esophagus, Heart and Vassals compression
Increased erythrocyte Weight loss sedimentation more Low-grade than 30 mm / h Leukocytosis fever Increased Fatigue fibrinogen, haptoglob Polyarthralgia in, gamma- globulin, seromucoid, Cutaneous C-reactive proteinnon-specific rash Hyperenzymemia Hypercalcemia Hyperkalemia Anemia.
A 57-year- old female patient was treated from respiratory infection that was complicated with pneumonia in February of 2011 year. After two weeks she noticed increased dyspnea, tachycardia
In may, The patient presented in polyclinic with complains of dyspnea, fatigue and cardiac abnormalitiesEchocardiography showed changes of pericardium. Patient was hospitalized and treated with diagnosis “Pericarditis of unknown etiology. Atrial fibrillation”
• ESR – 35 mm/h • Increased C-reactive Full blood count protein, hyponatremia and hypocalcemia • Increased fibrinogen, alpha 2 - globulin and beta-globulin. •Atrial fibrillation • 135 bpm heart rateElectrocardiography • Deflection of the electrical axis of the heart to the left •QRS electrical alternant •Diffuse myocardial changes of left ventricle.
Normal left ventricular dimensions and systolic function, compaction of walls of the aorta andEchocardiography aortic valves, hyperechoic tumor mass in the top of left ventricle. (Hydropericarditis )150 ml of pericardial fluid
•NormalBronchoscopy • Atypical cells were not found Breast ultrasound The cyst of left breast
The patient presented with complains of increased dyspnea, fatigue and was hospitalized in rheumatologic unit. (Hemo-) HydropercarditEchocardiography 600 ml of pericardial fluid. Risk of pericardial tamponade. Cardiomegaly. Elevated level cupula of left Chest X-ray diaphragm. Right pulmonary fibrosis. Deformed hilar in both sides.
Drainage of the pericardium of the right pleural cavity was done.There were no signs of cancer in cytological examinations.
Reduced volume of left lung. Chest Computer Line fibrosis of inferior lobetomography scan of left lung. with contrast Still present tumor mass in the top of left ventricle.Echocardiography Tumor mass in the top of left ventricle also. Chest x-ray Hydrothorax of left lob.
Examination showed presence of epithelial malignant tumor
The patient was totally examined. But location of primary tumor hadn’t been found. Diagnosis: “Metastasis in pericardium from undetectedlocation TхNхM1”. Stage IV. 4 clinical group. Germination in myocardium.”
ProgressiveEchocardiography germination in myocardium Right lower lob Chest X-ray pneumonia Lower third esophagus Bronchoscopy compression
The patient was places into the hospital on an emergency basis with cardiac decompensation
Hydropericarditis 200 mlEchocardiography Tumor mass in the top of left ventricle Right lower lob Chest X-ray pneumonia Right hydrothoraxElectrocardiography Sinus tachycardia
Ultrasound Fluid of Abdominal cavity MRI Mass of tumor The primary tumor’s location was not detected
Patient died of congestive heart failure despite intensive treatment Postmortem diagnosis: Right bronchoalveolar lung cancer withgermination in mediastinum and pericardiumMetostasis in lymphatic nodes, рТ4рN2рМ2.
The lungs tumor was debuted with symptoms of pericarditis, heart failure and arrhythmia. For the first time, tumor of pericardium was detected by Echocardiography.MRI and CT presented just clinical findings of line fibrosis and lower lobpneumonia, examinations didn’t detect primary tumor location.
Puncture of pericardium and Bronchoscopy with bronchopulmonary lavage were not effective infindings of primary tumor, atypical cells were not found. Epithelial malignant tumor was found only after biopsy. In case the biopsy in early stage had been performed the tumor mass would have been found on the stage where the immediate actions would have been more successful .
Th a n k y o u f o r y o u r a t t e n t i o n !!!