Massive pericardial effusion produced by extracardiac malignant neoplasms

Twelve patients with extracardiac malignant neoplasms and signs of severe systemic venous hypertension were admitted during the last three years to our service. It was the initial manifestation of malignant disease in six patients. Echocardiograms revealed large pericardial effusion in the 12 patients and six patients met the clinical criteria of cardiac tamponade. Pericardiocentesis was a safe procedure to give temporary relief to their problem. Cytologic examination of the pericardial fluid disclosed malignant neoplasms in 11 cases (91.6%), enabling us to make histological diagnosis in five. The most frequent site of origin was the lung (eight cases), adenocarcinoma being the predominant histologic feature. We conclude that metastatic pericardial disease must be considered as a frequent cause when a patient is initially seen with a massive pericardial effusion and/or cardiac tamponade that worsens with prognosis.