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El tampón cardíaco como la presentación inicial del carcinoma de células escamosas del pulmón: un informe de caso y

Vijay Bharti1, Zakaria Alagha1,2, Michael Smith1

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El derrame pericárdico es una presentación inicial poco común del carcinoma de células escamosas del pulmón (CCP). Este caso pone de relieve la importancia de sospechar malignidad en efusiones pericárdicas, incluso con síntomas atípicos, para evitar el diagnóstico tardío y mejorar los resultados del paciente.

Palabras clave:
tamponado cardíacoCáncer de pulmón de células no pequeñasen el campo de la oncologíaefusión pericárdicaCarcinoma de células escamosas del pulmón

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Área de la Ciencia:

  • En el campo de la oncología
  • Cardiología
  • Pulmonología

Sus antecedentes:

  • El carcinoma de células escamosas (CCS) del pulmón, un subtipo de cáncer de pulmón de células no pequeñas (CPNP), rara vez se presenta inicialmente con derrame pericárdico.
  • Los derrames pericárdicos se encuentran en el 10-12% de los casos de cáncer de pulmón, pero la presentación inicial es infrecuente.
  • El derrame pericárdico maligno puede conducir a un tamponamiento cardíaco, una condición que pone en peligro la vida.

Objetivo del estudio:

  • Para reportar un caso raro de SCC pulmonar que se presenta inicialmente como un derrame pericárdico maligno que causa tamponado cardíaco.
  • Hacer hincapié en los desafíos de diagnóstico y la importancia clínica de los derrames pericárdicos en oncología.
  • Para resaltar la importancia de la alta sospecha de malignidad en los derrames pericárdicos, independientemente de las presentaciones atípicas.

Principales métodos:

  • Informe de caso de un hombre de 68 años con enfermedades preexistentes (diabetes, EPOC).
  • Presentación inicial con síntomas que imitan la enfermedad hepatobiliar.
  • El diagnóstico incluyó imágenes (tomografía computarizada), ecocardiografía y citología del líquido pericárdico, seguido de una biopsia de masa pulmonar.

Principales resultados:

  • El hallazgo accidental de un gran derrame pericárdico que causa tamponamiento cardíaco.
  • La citología del fluido pericárdico confirmó la malignidad; la biopsia de la masa pulmonar diagnosticó SCC.
  • El paciente desarrolló insuficiencia respiratoria y neumotórax, lo que llevó a la atención de hospicio.

Conclusiones:

  • El derrame pericárdico requiere una ecocardiografía inmediata y una pericardiocentesis para la evaluación citológica.
  • Los derrames relacionados con el NSCLC indican enfermedad en estadio IV, manejada paliativamente.
  • La sospecha temprana y la evaluación de los derrames pericárdicos para la malignidad son cruciales para evitar el diagnóstico tardío y reducir la morbilidad del paciente.