Treating a Metastatic Pericardial Tumor

Pericardial involvement of metastatic adenocarcinoma is rare, and its treatment has historically involved several strategies.

We describe a case of pericardial metastasis from gastrointestinal adenocarcinoma presenting with pericardial syndrome of effusive-constrictive pericarditis (ECP), managed with pericardiocentesis and drain placement followed by 10 cycles of systemic chemotherapy, leading to the resolution of pericardial disease and improved quality of life.

Treatment strategies for malignant ECP in lieu of pericardiectomy have included pericardiocentesis only or pericardiocentesis with chemotherapy (either local, systemic, or both). Our approach at MD Anderson Cancer Center is to perform pericardiocentesis with temporary pericardial drain placement to decrease reaccumulation rate, followed by systemic chemotherapy to reduce pericardial tumor infiltration but limit sclerosing effect.

The combination of pericardiocentesis with drain placement for 3 to 5 days postpericardiocentesis followed by systemic chemotherapy can be a successful treatment strategy in ECP due to metastatic pericardial disease.