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Cardiac Tamponade Secondary to Metastasis from Adenocarcinoma of the Parotid Gland.

Barbetakis NG, Vassiliadis M, Krikeli M, Antoniadis T, Tsilikas C - World J Surg Oncol (2003)

Bottom Line: When occurs it is mainly from the lung, breast and the neoplasms of the lymphoreticular system.Hematogenous spread of parotid adenocarcinoma to heart is extremely rare and only two cases have been reported in literature so far.The patient was successfully treated with pericardial drainage and intrapericardial injection of chemotherapeutic agent to control recurrent pericardial effusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, Theagenion Cancer Hospital, Alexandrou Simeonidi 2, Thessaloniki, Greece. nibarb@otenet.gr

ABSTRACT
BACKGROUND: Metastatic involvement of pericardium producing cardiac tamponade is rare. When occurs it is mainly from the lung, breast and the neoplasms of the lymphoreticular system. Hematogenous spread of parotid adenocarcinoma to heart is extremely rare and only two cases have been reported in literature so far. CASE PRESENTATION: We report an unusual case of a patient with adenocarcinoma of the parotid gland, which presented with cardiac tamponade and was treated urgently with pericardial drainage and intrapericardial injection of cisplatin. CONCLUSIONS: Our case demonstrates the possibility of metastatic pericardial involvement and cardiac tamponade in patients with parotid adenocarcinoma. The patient was successfully treated with pericardial drainage and intrapericardial injection of chemotherapeutic agent to control recurrent pericardial effusion.

No MeSH data available.


Related in: MedlinePlus

Chest roentgenogram showing increased cardiac shadow due to pericardial effusion.
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Figure 1: Chest roentgenogram showing increased cardiac shadow due to pericardial effusion.

Mentions: Seven months later she was readmitted with a 3-day history of dyspnea, dry cough, chest pain, fatigue and lower extremity edema. She was afebrile with normal laboratory blood tests. Physical examination revealed facial plethora, orthopnea, tachypnea, jugular venous distention, peripheral cyanosis, distant heart sounds, decreased breath sounds at both lung bases and a blood pressure 90/55 mm Hg. Admission chest X-ray showed increased cardiothoracic ratio without pulmonary congestion (Figure 1). The electrocardiogram revealed sinus tachycardia, low QRS voltage and presence of total electrical alternans involving both atrial and ventricular complexes. An emergency echocardiogram disclosed massive pericardial effusion with right atrial and ventricular collapse. A thoracic CT scan demonstrated a large pericardial effusion without any evidence of intrathoracic lymphadenopathy, superior vena cava obstruction or metastases (Figure 2). Diagnostic right heart catheterization revealed a central venous pressure of 21 cm H2O, a right ventricular pressure of 40/21 mm Hg and a pulmonary artery pressure of 22 mm Hg. A diagnosis of cardiac tamponade was established. Pericardiocentesis was performed and 750 ml of serosanguinous pericardial fluid were aspirated. Cytologic examination was positive for malignant cells having features of adenocarcinoma (Figure 3). The patient tolerated the procedure well without complications and experienced immediate clinical improvement. After five days, when daily accumulation of pericardial fluid decreased below 30 ml, we instilled 30 mg of cisplatin into the pericardial cavity and the catheter was removed. The patient underwent chest X-rays and three echocardiograms during the next 10 days which revealed no recurrent pericardial effusion (Figure 4 and 5). There were no complications related to the cisplatin installation. Her condition improved and she was discharged. She is alive and disease free at 5 months of follow-up.


Cardiac Tamponade Secondary to Metastasis from Adenocarcinoma of the Parotid Gland.

Barbetakis NG, Vassiliadis M, Krikeli M, Antoniadis T, Tsilikas C - World J Surg Oncol (2003)

Chest roentgenogram showing increased cardiac shadow due to pericardial effusion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC239964&req=5

Figure 1: Chest roentgenogram showing increased cardiac shadow due to pericardial effusion.
Mentions: Seven months later she was readmitted with a 3-day history of dyspnea, dry cough, chest pain, fatigue and lower extremity edema. She was afebrile with normal laboratory blood tests. Physical examination revealed facial plethora, orthopnea, tachypnea, jugular venous distention, peripheral cyanosis, distant heart sounds, decreased breath sounds at both lung bases and a blood pressure 90/55 mm Hg. Admission chest X-ray showed increased cardiothoracic ratio without pulmonary congestion (Figure 1). The electrocardiogram revealed sinus tachycardia, low QRS voltage and presence of total electrical alternans involving both atrial and ventricular complexes. An emergency echocardiogram disclosed massive pericardial effusion with right atrial and ventricular collapse. A thoracic CT scan demonstrated a large pericardial effusion without any evidence of intrathoracic lymphadenopathy, superior vena cava obstruction or metastases (Figure 2). Diagnostic right heart catheterization revealed a central venous pressure of 21 cm H2O, a right ventricular pressure of 40/21 mm Hg and a pulmonary artery pressure of 22 mm Hg. A diagnosis of cardiac tamponade was established. Pericardiocentesis was performed and 750 ml of serosanguinous pericardial fluid were aspirated. Cytologic examination was positive for malignant cells having features of adenocarcinoma (Figure 3). The patient tolerated the procedure well without complications and experienced immediate clinical improvement. After five days, when daily accumulation of pericardial fluid decreased below 30 ml, we instilled 30 mg of cisplatin into the pericardial cavity and the catheter was removed. The patient underwent chest X-rays and three echocardiograms during the next 10 days which revealed no recurrent pericardial effusion (Figure 4 and 5). There were no complications related to the cisplatin installation. Her condition improved and she was discharged. She is alive and disease free at 5 months of follow-up.

Bottom Line: When occurs it is mainly from the lung, breast and the neoplasms of the lymphoreticular system.Hematogenous spread of parotid adenocarcinoma to heart is extremely rare and only two cases have been reported in literature so far.The patient was successfully treated with pericardial drainage and intrapericardial injection of chemotherapeutic agent to control recurrent pericardial effusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, Theagenion Cancer Hospital, Alexandrou Simeonidi 2, Thessaloniki, Greece. nibarb@otenet.gr

ABSTRACT
BACKGROUND: Metastatic involvement of pericardium producing cardiac tamponade is rare. When occurs it is mainly from the lung, breast and the neoplasms of the lymphoreticular system. Hematogenous spread of parotid adenocarcinoma to heart is extremely rare and only two cases have been reported in literature so far. CASE PRESENTATION: We report an unusual case of a patient with adenocarcinoma of the parotid gland, which presented with cardiac tamponade and was treated urgently with pericardial drainage and intrapericardial injection of cisplatin. CONCLUSIONS: Our case demonstrates the possibility of metastatic pericardial involvement and cardiac tamponade in patients with parotid adenocarcinoma. The patient was successfully treated with pericardial drainage and intrapericardial injection of chemotherapeutic agent to control recurrent pericardial effusion.

No MeSH data available.


Related in: MedlinePlus