[Cardiac tamponade disclosing neoplasm: apropos of 23 cases]

The authors report a series of cardio-pericardial metastases presenting acutely with tamponade. There were 14 men and 9 women with an average age of 39 years. The primary tumour was mainly bronchial in the men (5 cases: 20.8%) and breast (3 cases: 16.6%) or uterine (4 cases: 16.6%) in the women. The other malignancies were blood dyscrasias (5 NHL and 1 MHL) one pericardial mesothelioma, one Schwannoma, one Ewing's sarcoma and one carcinoma of the larynx. The primary tumour was not found in one case. Echocardiography showed a large, circumferential pericardial effusion in all cases and compressing the right heart chambers (RA and/or RV) in half the cases. Rounded echogenic masses implanted on the pericardial membranes (2 cases) or images of false membranes (10 cases) were also demonstrated. The clinical emergency led to pericardiocentesis with surgical drainage in 5 cases. A pleuro-pericardial window was fashioned in 4 cases. The effusion was important in all cases and bloody in 75% of cases. Cytology of the pericardial liquid was positive for malignant cells in 1 out of 2 cases. The diagnosis was made after death in 3 cases. The other biopsies, bronchial, lymph node, pleural and bone marrow also provided valuable diagnostic information. Undifferentiated carcinoma was found in 75% of bronchial carcinomas. In all three breast tumours, the histology showed moderately well differentiated adenocarcinoma. The authors underline the paucity of therapeutic measures: at this stage, pericardiocentesis is almost the only procedure apart from the cases of haemopathy. Some authors have suggested radiotherapy of the precordial region and others, intrapericardial chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)