Cardiac tamponade as the initial presentation of malignancy

Although neoplastic involvement of the pericardium frequently is present postmortem, cardiac manifestations before death are uncommon, and cardiac tamponade as the initial presentation of cancer is rare. In this study, a malignancy was first recognized in eight of 23 patients (35 percent) who presented with cardiac tamponade. Seven of these eight patients had lung and one patient thyroid carcinoma. The prognosis of these eight patients was poor with seven of eight patients dead within a mean of seven weeks (range 2.5 to 16). Overall, pericardial fluid cytology demonstrated a specific diagnosis of malignancy in 14 of 19 patients (74 percent). Earlier recognition of the possibility of malignancy may allow initiation of appropriate local or systemic treatment to lessen the probability of cardiac tamponade and improve survival. We recommend that all patients who present with tamponade have cytology performed on the pericardial fluid, even if malignancy is not suspected initially.