malignant pericardial effusion from MBC

1. CPC
2021-10-28
一般外科 楊誠群醫師

2. Case Presentation
2021-05-10
 A 63 Y/O female came to our CHEST OPD due to chief
complaints of chronic cough with sputum, rhinorrhea,
dyspnea
 PH of H/T under regular Rx in LMD
 BP: 225/134 mmHg, HR : 114/min
 PE : clear breathing sounds, no wheezing
no congested throat
 CXR : Cardiomegaly
 Rx : Medication for URI & referred to CV OPD

3. 2021-05-10

4. Case Presentation
2021-05-28
 She was referred from LMD to our CV OPD due to
SOB with lower leg edema for 1 week
 Lab Data in LMD : normal RFT, normal Albumin level,
no proteinuria
 BP : 181/128 mmHg, HR : 128/min
 Impression : CHF
 Rx : EKG, LDL, cholesterol, triglyceride, sugar,
creatinine, AST, K
 Medication : Lasix, Sevikar, Bisoprolol
 Arrange Cardiac echo on 2021-06-04

5. 2021-05-28

6. Case Presentation
2021-06-04
 Cardiac echo : massive pericardial effusion with
cardiac tamponade, normal heart size with good LV
systolic function
 Referred to ER for emergent pericardio-centesis
with central-vein-catheter drainage
 560 ml bloody fluid drained out, sent for cytology

7. 2021-06-04

8. Cardiac Echo
2021-06-04

9. Cardiac Echo
2021-06-04

10. CXR
2021-06-04

11. CXR
2021-06-05

12. Case Presentation
2021-06-04
 Admission to ICU for intensive observation &
treatment
 PE : right breast lump over UOQ
about 2 cm in size
the mass is firm & fixed
palpable enlarged LNs over right axilla

13. Cytology of pericardial effusion
2021-06-08
 Metastatic adenocarcinoma

14. CT of Chest + Abdomen
2021-06-08

15. Breast Echo
2021-06-09

16. Mammography
2021-06-09
CC view

17. Mammography
2021-06-09
MLO view

18. Core Needle Biopsy
 Right : invasive ductal carcinoma
 Left : ductal carcinoma in situ
 IHC stains :
 ER : 90%
 PR : 90%
 HER-2 expression : 1+
 KI-67: positive in 30-40% tumor cell
 Luminal-B HER-2 (-)
 Stage IV cT3cN3M1

19. 1st line Rx of HR (+) HER-2 (-) MBC

20. CXR
2021-06-24

21. Case Presentation
2021-08-31
 Early return to OPD due to recurrent dyspnea for
3-4 days
 No lower leg edema
 No JVE
 Right breast lump decreased in size by palpation
 Referred to ER for urgent checkup

22. CXR
2021-08-31

23. 2021-08-31

24. Cardiac Echo
2021-09-01

25. CT of Chest + Abdomen
2021-09-02

26. Transfer to TaoYuan Hospital
2021-09-03
 Urgent Radiotherapy
 Chemotherapy is recommended

27. Discussion
 Neoplastic pericardial effusion
 Acquired extrinsic pulmonary artery
stenosis caused by mediastinal
tumors

28. Aetiology of pericardial effusion
2015 ESC Guidelines for the diagnosis and management of pericardial diseases

29. Neoplastic pericardial effusion
Primary
 Mesothelioma
 Angiosarcoma
 Fibrosarcoma
 Liposarcoma
Seconday
 Lung cancer
 Breast cancer
 Malignant melanoma
 Lymphoma
 Leukemia
Maisch B, Evaluation and management of pericardial effusion in patients with neoplastic disease.
Prog Cardiovasc Dis 2010;53:157 – 163.

30. Recommendations for the diagnosis and management of
neoplastic pericardial effusion
2015 ESC Guidelines for the diagnosis and management of pericardial diseases

31. Recommendations for the diagnosis and management of
neoplastic pericardial effusion
2015 ESC Guidelines for the diagnosis and management of pericardial diseases

33. Recommendations for the diagnosis and management of
neoplastic pericardial effusion
2015 ESC Guidelines for the diagnosis and management of pericardial diseases

34. J Thorac Cardiovasc Surg 2014 NOV 01 (1-6)

35. Acquired extrinsic pulmonary artery stenosis
 Anterior mediastinal tumors
 Aortic aneurysms
 Mediastinal cysts
 Sternal tumors (benign or malignant)
 Fibrosing mediastinitis
 Pericardial disease
Littler WA, Acquired pulmonary stenosis. Thorax 1970; 25:465-471.

36. Acquired extrinsic pulmonary artery stenosis
caused by mediastinal tumors
 Clinically detectable pulmonic stenosis resulting from
compression of the pulmonary artery or right ventricular
outflow tract by mediastinal tumors is rare.
M E Marshal Cancer 1982 Apr 1;49(7):1496-9.

37. Journal of Oncology Volume 2009, Article ID 579407, 3 pages

38. Clinical Case Reports 2017; 5(10): 1591–1593

41. Percutaneous Endo-vascular Stenting for
Acquired Extrinsic Pulmonary Artery Stenosis

42. Circulation. 2011;123:1391-1399.

43. Circulation. 2011;123:1391-1399.

44. Christian Fierro-Renoy, CHEST 2002; 122 (1478–1480)
From the Department of Medicine, Division of Cardiology,
University of Miami-Veterans Administration Hospital

45. Christian Fierro-Renoy, CHEST 2002; 122 (1478–1480)
From the Department of Medicine, Division of Cardiology,
University of Miami-Veterans Administration Hospital

46. Christian Fierro-Renoy, CHEST 2002; 122 (1478–1480)
From the Department of Medicine, Division of Cardiology,
University of Miami-Veterans Administration Hospital

47. Giuseppe Giordano, Unit of Diagnostic and Interventional Radiology ,ARNAS, Catania, Italy

48. Giuseppe Giordano, Unit of Diagnostic and Interventional Radiology ,ARNAS, Catania, Italy

49. Take Home Message
 Neoplastic pericardial effusion should be carefully D.D.
with CHF in cancer patients with cardiomegaly.
 The most common etiology of neoplastic pericardial
effusion is lung cancer, breast cancer & lymphoma.
 Follow the 2015 ESC Guidelines for the diagnosis and
management of Neoplastic pericardial disease.
 Extrinsic pulmonary artery stenosis caused by
mediastinal tumors is rare.
 Percutaneous endo-vascular stenting for extrinsic
pulmonary artery stenosis by mediastinal tumors seems
to be promising.