[Metastatic cardiac tamponade as initial manifestation of papillary thyroid carcinoma]

Papillary carcinoma, diffuse sclerosing variant corresponds to 2% of all papillary thyroid carcinomas. It is usually diffuse and bilateral, affecting the entire gland. At the time of diagnosis, patients present lymph node and lung metastasis. It affects mainly young women. This case report describes a cardiac tamponade as the initial manifestation of an unusual variant of papillary thyroid carcinoma. A 32 year-old woman was attended at the emergency room with epigastric pain and dry cough. Physical examination revealed hypotension, tachycardia and decreased heart sounds. An echocardiogram confirmed severe pericardial effusion. Pericardial fluid cytology was positive for malignancy. The patient evolved with recurrent pericardial effusion and a pleuropericardial window was performed. At this procedure, a subpleural nodular lesion was found, which histology corresponded to metastases of papillary carcinoma, probably from thyroid origin. Total thyroidectomy was performed. The final diagnosis was papillary carcinoma, diffuse sclerosing variant. This variant infiltrates the connective tissue of the interfollicular spaces, mimicking thyroiditis and it is associated with early vascular permeation. This tumor, compared to the classic variants of thyroid carcinoma, is more aggressive and it has higher risk of recurrence. Papillary thyroid carcinoma should be considered as differential diagnosis in our population, in all metastatic papillary lesions, and even more in young female patients.